Under-Eye Filler Complications & Revision

The under-eye is probably the area I see most in filler revision, and the hardest to settle. People assume the tear trough is just a sunken groove you fill in — but it’s actually a ligament pulling the skin down. If that ligament isn’t released first, whatever you inject gets squeezed off course: up into the eye bag, down into the cheek, while the trough stays hollow. The skin here is thin, too — HA placed too shallow turns blue (Tyndall), overfilled it becomes a caterpillar ridge; and once a collagen stimulator or grafted fat hardens into a lump, hyaluronidase can’t dissolve it and it has to be removed bit by bit under ultrasound. So the under-eye is never really about “not enough filler” — it’s about seeing clearly where the material has gone and what the structural problem is, then deciding whether to release, reposition, or remove. Organised here by sub-area (tear trough, aegyo-sal, upper eyelid, dark circles, eye bags) are my approaches and the logic of what can be dissolved versus what can only be removed.