Under-eye filler injections, often used to reduce the appearance of dark circles or hollows, have become increasingly popular. While many patients are pleased with the results in the short term, it’s important to understand that this is a medical procedure with potential risks and long-term implications.
There are five key risks of under eye filler injections.
1. Discolouration and swelling
One of the most common cosmetic complications is a bluish tint under the eyes, known as the Tyndall effect. This occurs when filler is injected too superficially and light reflects off the product beneath the skin. In some cases, persistent puffiness or malar oedema can develop due to impaired lymphatic drainage in the area, particularly in individuals with poor tissue elasticity or improper injection technique. This can be particularly distressing and difficult to treat. Retained or Migrated Hyaluronic Acid fillers can persist for years (well beyond expected degradation time) and may appear as soft-tissue fullness mimicking fat herniation or oedema.
2. Infection and immune reactions
As with any injection, there is a risk of infection. Though rare, infections can lead to redness, pain, and swelling, and may require antibiotics or even drainage. More recently, concerns have been raised about the potential for dermal fillers, especially those containing hyaluronic acid, to interfere with the immune system by blocking lymphatic channels, leading to low-grade immune responses or interference with systemic immunity. This could theoretically increase the risk of other health issues, although more research is needed. These reactions may be delayed, appearing weeks to months after injection.
3. Complications with future surgery
Patients who later consider eyelid surgery (blepharoplasty) or facelifts may face complications if they’ve previously had fillers. Surgeons have reported that fillers can cause scarring, tethering of tissues, and distortion of normal anatomy, making surgery more complex and less predictable.
In some cases, filler material can persist for years, even when it was expected to dissolve within months. Imaging studies confirm filler persistence and migration years after injection. Many surgeons recommend using hyaluronidase before surgery to dissolve remaining filler and restore natural anatomy.
Filler also impairs lymphatic drainage in the infraorbital region. This can cause chronic fluid retention even months or years later. Surgery can exacerbate pre-existing filler-related lymphatic congestion, and the presence of filler may significantly increase the time it takes for the post-operative swelling to resolve, from weeks to months.
Some fillers provoke low-grade inflammation, leading to fibrosis or irregular swelling. This may distort normal anatomy, increasing surgical trauma and post-operative swelling. This also makes the outcomes of the surgery less predictable.
4. Rejection and lumps
Although hyaluronic acid is naturally found in the body, some individuals may still react to filler products. This can result in the development of lumps, nodules, or granulomas in the area of filler injection. Granulomas are small areas of inflammation that may require medical treatment or removal. These reactions can occur weeks or even months after the injection, due to immune sensitivity or bacterial contamination and are especially problematic when delayed, as they are harder to attribute to the filler.
5. Rare but serious risks: vision loss
Perhaps the most serious risk, though extremely rare, is blindness. This can occur if filler is accidentally injected into a blood vessel that supplies the eye, leading to blockage of the retinal artery. While this is a rare complication, it is irreversible and highlights the importance of choosing a highly trained medical professional for any injectable treatment.
Why surgery might be a better choice
Under-eye fillers can offer a quick, non-surgical fix but surgery, such as lower eyelid blepharoplasty, may be a more suitable and lasting solution for many patients.
Surgical correction allows for precise removal or repositioning of fat and excess skin, directly addressing the root causes of under-eye bags or hollows rather than masking them. Unlike fillers, which may need repeated treatments and can cause complications over time, surgery provides a more permanent result with fewer long-term risks and avoids the cumulative risks associated with repeated filler injections.
Additionally, surgical outcomes are typically more predictable and can be tailored to individual anatomy, especially in the hands of an experienced oculoplastic eye surgeon. Surgery, compared to filler injections, is associated with fewer long-term complications.
For patients seeking a definitive and natural-looking improvement, particularly those with significant anatomical changes or previous filler complications, surgery may offer a safer and more effective path forward.
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