I chose to write about this topic after seeing several difficult under-eye filler cases over the past three months. I believe it's crucial for patients to be well-informed before undergoing treatments, especially around the eyes, where complications can not only make you look worse but can also be challenging and expensive to fix.
The Rise of Under-Eye Fillers
Hyaluronic acid (HA) fillers like Restylane and Juvederm have become incredibly popular. These fillers help restore facial volume and improve contour. Our skin naturally contains hyaluronic acid — it's what gives children that youthful, plump appearance. As we age, our HA levels decline, leading to volume loss and visible signs of aging.
Under-eye HA fillers are typically injected deep against the bone of the lower eye socket. Depending on the type of filler used, they can last anywhere from 12 to 24 months. However, under-eye fillers don’t always behave as expected. For reasons we still don’t fully understand, fillers in this area often don't dissolve on schedule and can lead to chronic lower eyelid swelling (edema) — sometimes mild, sometimes quite noticeable. This swelling can also give the skin a bluish tint, often referred to as the "Tyndall effect".
My Most Important Advice
Always choose an experienced injector, whether it's for Botox or fillers.
Do not make your decision based on price alone. This is especially true for under-eye fillers, where complications are more common and more difficult to treat. If complications arise, HA fillers can be dissolved to some extent, but it’s not always straightforward.
Key Takeaways
1. Avoid Under-Eye Fillers When Possible
If you do decide to go ahead with treatment, ask your injector about their policy for handling complications, such as swelling or edema, which can happen immediately or even years later (yes, even a decade!). Ask if they’ll handle the dissolving process and whether there will be additional costs involved.
2. Don’t Keep Re-Filling Every Year
In the under-eye area, fillers often don’t dissolve completely. Continuous refilling can lead to accumulation and persistent swelling.
Pro tip: Have your injector take “before” photos so you can track how your appearance changes over time and understand your baseline.
3. Dissolving Under-Eye Fillers Isn’t Always Simple
Edema from fillers can be stubborn and may require large amounts of dissolving enzyme, sometimes up to 100–300+ units of Hylenex.
What to Expect If You Need Fillers Dissolved
A. You might look older or more wrinkled after dissolving.
This is a return to your natural appearance — what you would look like without fillers.
B. Dissolving is often the best choice to avoid long-term damage.
Chronic swelling can stretch the delicate under-eye skin permanently. Even partial improvement without losing all the volume is considered a win.
C. Some cases may require surgery.
If filler edema doesn't respond to even aggressive dissolving (up to 3–4 vials of enzyme), I may recommend a cosmetic lower eyelid blepharoplasty. This is performed in the operating room at 900 North Michigan. During surgery, I also inject enzyme directly into the edema.
This technique was taught to me by my mentor, Dr. Steve Fagien in Boca Raton, Florida.
D. I deeply empathize with patients facing these issues.
It’s incredibly painful (emotionally and financially) to feel worse after an elective cosmetic procedure. If you’re struggling with swelling, please do not cover it up with more filler. Seek expert advice first.
Final Thoughts
Do your research. Choose your injector carefully. And remember — sometimes, doing less is more when it comes to under-eye treatments.
