Fillers can cause swelling under the eyes if they are placed too close to the surface, as they attract water. The type of filler used should be carefully selected, as different fillers vary in the amount of water they attract and, therefore, in the potential they have to cause swelling. Tear canals are a complex area to treat and should only be tested by experienced injectors. When done correctly, dermal fillers in the tear canal can reduce the appearance of tiredness under the eyes and enhance the sunken effect that occurs as we age.
Treatment of lacrimal canals should only be performed by experienced professionals. Poor choice of filler, lack of understanding of the patient's anatomy or poor selection of patients can lead to problems. In most cases, hyaluronic acid facial filler products that were previously injected into an unsuitable tissue plane can be dissolved by hyaluronidase injections. Dark circles are difficult to treat and dermal filler treatment will not remove pigmentation.
Hyaluronic acid facial fillers can still be seen in the area under the eyes for many years after the injection (in some cases, this can happen five years later or more). Not all injectors that can pick up a syringe and perform facial filler injections are qualified with the specific knowledge and advanced technical expertise necessary to perform this procedure properly and effectively. I have seen many problems arise from people who put fillers under their eyes to camouflage the fat changes that come with aging. But can the procedure be counterproductive? Can fillers worsen the eye area? The answer is, unfortunately, yes. Non-medical extenders, such as physician assistants, nurse practitioners, general nurses, and medical beauticians can also participate in injecting fillers into the face.
Although major complications with facial filler injections under the eyes (lacrimal rejuvenation) are uncommon in general; unfortunately, they can occur, as with any facial filling procedure, even if the injection was performed by a qualified and expert injector. Normal structures usually found in this area include the skin of the lower eyelid, the eyelid muscle, and the tissue that covers the bone of the eye socket. If a facial filler product is placed too shallow on the skin or on top of the muscle layer, it may settle with an abnormal appearance and may appear bulky, swollen, or uneven. If your filler goes directly under the eye, your dermatologist will likely use a hyaluronic acid filler such as Restylane, Belotero or Juvederm which can also be used on other parts of the face. What is concerning is that these people often end up in the hands of a diverse and not always qualified group of facial filler injectors.
While experienced expert injectors can improve the appearance of bulging fat in this area, surgery around the eyes to remove and reposition fat that protrudes forward around the eyes is often more effective.