I’m considering getting under-eye fillers to address dark circles and hollowness that make me look tired. I’ve heard they can be quite effective, but also that the under-eye area is delicate. What are the potential risks and side effects of under-eye fillers, both short-term and long-term? I’m particularly concerned about things like lumps, Tyndall effect (bluish discoloration), prolonged swelling, vision problems, and any longer-term complications that might not be immediately apparent. Also, are there specific risk factors that would make someone a less suitable candidate for this procedure, and are there ways to minimize these risks during and after the treatment?

Answer

Potential risks and side effects of under-eye fillers include:

Common Side Effects (Generally Temporary):

• Bruising: This is a frequent occurrence due to the delicate skin and numerous blood vessels around the eyes. The severity can vary from minor discoloration to more pronounced bruising. It usually resolves within a week to two weeks. Certain medications (like aspirin or ibuprofen) and supplements (like fish oil) can increase the risk and duration of bruising.

• Swelling (Edema): Injection causes trauma, leading to fluid accumulation. Swelling is typically most pronounced in the first few days after treatment and gradually subsides over one to two weeks. Sleeping with your head elevated can help minimize swelling.

• Redness: The injection site may appear red immediately after the procedure. This usually fades within a few hours to a day.

• Tenderness or Pain: Mild discomfort or tenderness to the touch is common. This is usually easily managed with over-the-counter pain relievers, if needed.

• Lumpiness or Nodules: Small, palpable lumps or nodules may form under the skin, particularly if the filler is not evenly distributed or if too much filler is injected. These may resolve on their own over time. Massage can sometimes help to smooth them out. Hyaluronidase can be used to dissolve HA fillers if the lumps are persistent or bothersome.

• Tyndall Effect (Bluish Discoloration): If the filler is placed too superficially, it can create a bluish tint under the skin. This is due to the way light scatters through the filler material. Hyaluronidase can dissolve the filler and correct this.

Less Common but More Serious Risks:

• Infection: Although rare with proper sterile technique, infection is a possibility with any injection. Signs of infection include increasing pain, redness, swelling, warmth, and potentially pus or drainage. Antibiotics are required to treat infections.

• Allergic Reaction: Allergic reactions to the filler itself are rare, especially with hyaluronic acid fillers as they are biocompatible. However, reactions to other components of the filler product (e.g., lidocaine) or to cleaning solutions used during the procedure are possible. Symptoms can range from mild itching and rash to severe anaphylaxis (which is life-threatening and requires immediate medical attention).

• Vascular Occlusion (Blood Vessel Blockage): This is the most serious and potentially devastating complication. It occurs when filler is inadvertently injected into a blood vessel, blocking blood flow. If a blood vessel supplying the skin is blocked, it can lead to skin necrosis (tissue death), resulting in scarring. If a blood vessel supplying the eye is blocked (e.g., the ophthalmic artery), it can lead to blindness. Symptoms of vascular occlusion can include immediate and severe pain, blanching (whitening) of the skin, mottling (patchy discoloration), and delayed capillary refill. Prompt recognition and treatment with hyaluronidase (for HA fillers) and other supportive measures are crucial to minimize damage.

• Blindness: As mentioned above, blindness is a rare but devastating complication of vascular occlusion. The filler can travel retrograde (backwards) into the retinal arteries, causing irreversible damage. It is more likely to occur with injections near the nose and glabella (between the eyebrows) because of vascular connections to the ophthalmic artery.

• Vision Changes: Other vision changes, such as double vision (diplopia) or drooping eyelid (ptosis), can also occur due to nerve or muscle damage, or swelling.

• Nerve Damage: While uncommon, damage to nerves can occur during the injection process, leading to temporary or permanent numbness, tingling, or weakness in the treated area.

• Granuloma Formation: Rarely, the body can form granulomas (small nodules of inflammatory cells) in response to the filler material. Granulomas can occur months or even years after the injection. Treatment may involve corticosteroids or other medications.

• Scarring: While uncommon, scarring can occur as a result of infection, skin necrosis, or granuloma formation.

• Overcorrection or Asymmetry: Injecting too much filler can lead to an unnatural or overfilled appearance. Asymmetry (unevenness) can also occur if the filler is not injected evenly or if one side of the face responds differently to the treatment.

Factors That Can Increase the Risk:

• Inexperienced Injector: Choosing an unqualified or inexperienced injector significantly increases the risk of complications. It is crucial to select a qualified and experienced practitioner who has a thorough understanding of facial anatomy and injection techniques.

• Certain Medical Conditions: Individuals with certain medical conditions, such as autoimmune disorders or bleeding disorders, may be at higher risk of complications.

• Medications and Supplements: Certain medications and supplements, such as blood thinners, can increase the risk of bleeding and bruising.

• Smoking: Smoking can impair healing and increase the risk of complications.

• Non-Sterile Technique: Failure to follow proper sterile technique can increase the risk of infection.

Important Considerations:

• Thorough Consultation: A thorough consultation with a qualified injector is essential to discuss your goals, assess your suitability for the procedure, and understand the potential risks and benefits.

• Realistic Expectations: It is important to have realistic expectations about the results of under-eye filler treatment. Fillers can improve the appearance of under-eye hollows and dark circles, but they may not completely eliminate them.

• Emergency Plan: Ensure your injector has an emergency plan in place to manage potential complications, such as vascular occlusion, including immediate access to hyaluronidase (if using HA fillers) and other medications.

• Post-Treatment Care: Following your injector’s post-treatment instructions carefully is important to minimize the risk of complications and promote healing.