Under Eye Fillers Gone Wrong: Causes, Corrections, and Case Studies

Is under-eye filler safe? The answer depends entirely on the injector’s expertise, technique, and product choice. The skin under the eyes is prone to bruising, swelling, and filler misplacement, so being an expert in facial anatomy and complication management is essential. While this treatment can rejuvenate the tear trough area beautifully, it is one of the highest-risk zones for complications.

Why the Tear Trough Zone Is Prone to Complications

The tear trough is one of the most anatomically delicate facial areas. The skin here is paper-thin, with a dense network of capillaries and lymphatic channels. Any misstep, such as wrong depth, product, or volume, can result in long-lasting aesthetic or functional problems.

High risks include visible filler, contour irregularities, puffiness, or the Tyndall effect. Under-eye filler before and after images often reveal these miscalculations. Even a skilled injector can face challenges in this zone, which is why expertise and anatomical mastery are critical.

Key Mistakes Leading to Under-Eye Fillers Gone Wrong

Several clinical errors contribute to under-eye filler complications:

• Product selection: Using thick or hydrophilic fillers increases the chance of swelling, puffiness, or migration. The tear trough demands low-viscosity, low-hydrophilicity gels.
• Poor technique: Superficial injection leads to lumps and unnatural shadows. Injecting too deeply may affect the vasculature or fat pads, worsening hollowness.
• Improper tools: Needles offer precision but pose higher risks without extreme anatomical accuracy. Cannulas, when properly used, reduce trauma and help distribute filler safely.
• Overfilling: Less is more. Overcorrection, especially in mobile areas, leads to unnatural bulges that appear worse when the patient smiles or squints.
• Delayed swelling: Late-onset edema may occur due to lymphatic congestion or biofilm activation, sometimes presenting weeks after the procedure.

Signs Your Under-Eye Filler Went Wrong

Complications under the eyes may not present immediately after treatment. Some signs develop gradually, while others may become more obvious as the filler integrates or causes unintended effects. Early detection is critical for effective correction and patient reassurance.

The following are the most common clinical and aesthetic indicators that tear trough under-eye fillers have gone wrong:

• Blue-gray tint: A sign of the Tyndall effect under the eye. This occurs when filler sits too close to the skin’s surface.
• Chronic puffiness or heaviness: Persistent swelling, especially unilateral, can signal improper placement or a vascular response.
• Asymmetry or migration: Filler moving into adjacent areas, such as the upper cheek, can distort natural contours.
• Nodules or lumps: These may be inflammatory (biofilm-related) or due to poor product integration.
• Persistent redness or warmth: May indicate low-grade infection or inflammatory response, especially if localized and tender.
• Delayed onset swelling: Swelling that develops days or weeks later can result from lymphatic congestion or biofilm activity.
• Skin discoloration or mottling: Blotchy or dusky skin beyond the Tyndall effect may signal vascular compromise or product misplacement.
• Unnatural surface texture: Rippling or uneven texture can indicate superficial filler placement or poor integration.
• Tightness or restricted movement: Filler placed too close to muscles may cause discomfort or altered facial expression.

How to Fix Bad Under-Eye Fillers

How to fix tear trough filler complications depends on the type and severity of the issue. A proper diagnosis, distinguishing between structural and inflammatory causes, is essential before selecting the appropriate corrective approach. 

Treatment strategies may include: 

• Hyaluronidase is the go-to treatment for dissolving HA-based products and reversing under-eye fillers. Tailor dilution based on location and degree of correction needed.
• Inflammatory issues may benefit from steroids, antibiotics, or anti-biofilm protocols.
• Manual massage or microneedling can sometimes redistribute misplaced product, but must be performed with caution.
• In complex or unresponsive cases, referral to an oculoplastic specialist is strongly advised.

Clinical Strategies to Avoid Poor Outcomes

Prevention is always better than correction when it comes to dermal fillers under the eyes gone wrong:

• Use appropriate products: Redensity II and Belotero Balance are commonly recommended due to their softness and lower hydrophilicity.
• Favor cannulas: Blunt-tip cannulas minimize bruising and vascular injury, particularly when navigating tricky planes near the orbital rim.
• Start conservatively: Use small volumes and reassess after 2-3 weeks. Most patients do not need full correction in one session.
• Patient selection: Avoid treating patients with extreme hollowness, poor skin tone, active dermatitis, or unrealistic expectations.
• Document baseline photos: Essential for identifying under-eye fillers gone wrong pictures and providing medicolegal protection.

When a Bad Result Becomes a Crisis

Although rare, under-eye filler complications can occur, and when they do, swift and structured action is critical. Crisis scenarios may include vascular occlusion, allergic reactions, infection, or severe aesthetic distortion. Hands-on simulation and structured complication protocols, such as those outlined in the Aesthetics Complications masterclass, can significantly improve preparedness and response.

Each type of complication demands a tailored approach, but all require calm, clinical decision-making and preparedness:

• Assess the severity of the situation as the first step in any complication.

• For allergic or inflammatory responses:

• Stop treatment immediately.
• Document the reaction thoroughly.
• Administer antihistamines, corticosteroids, or other appropriate medications based on clinical judgment.

• For infections:

• Begin empiric antibiotic therapy.
• Consider drainage if abscess formation is suspected.

• For vascular compromise (the most serious complication):

• Look for signs such as pain, blanching, dusky skin, and visual disturbances to confirm vascular occlusion.
• Administer hyaluronidase immediately if occlusion is suspected. Massage the area and apply warmth to aid reperfusion.
• Refer urgently to the emergency department if any visual symptoms are present. Retinal artery occlusion is an ophthalmic emergency.

How to Achieve Optimal Results

Start with a holistic facial analysis. In many cases, correcting midface volume first improves tear trough appearance. Strategic layering over multiple sessions can enhance outcomes while minimizing complications.

Patient counseling is essential. Set expectations around likely results, the importance of follow-up, and the possibility of needing combination treatments to fully address concerns.

Training and Ongoing Education as the Best Prevention

Ongoing education enables injectors to stay current with evolving filler technologies, safety protocols, and new techniques for complex zones like the infraorbital region. Through practical workshops, cadaver-based anatomy sessions, and peer-reviewed video libraries, practitioners can refine their clinical judgment and response strategies.

Injectors looking to strengthen their foundation and enhance their clinical outcomes can explore a variety of aesthetic courses and tear trough filler training programs at HubMed Ed. These expert-led video classes provide structured guidance, complication management tactics, and real-world case analysis.

The Bottom Line

Under-eye fillers gone wrong can cause distress, but most issues are preventable or reversible. Understanding anatomy, product behavior, and complication management sets apart novice injectors from true experts. The key lies in education, discernment, and preparation.

Continued professional development is the most effective way to build confidence and consistency through educational platforms like HubMed Ed. By pursuing advanced training, practitioners can elevate their skill set and ensure every treatment ends in success.

FAQs

How can under-eye fillers go wrong?

Under-eye fillers can go wrong due to poor technique, improper product choice, or incorrect placement. This can lead to puffiness, discoloration, or asymmetry.

Are fillers under the eyes safe?

Yes, when performed by a skilled injector using the right product and method. However, the area is sensitive, and complications are more common than in other facial zones.

Who is a bad candidate for under-eye fillers?

Patients with thin, crepey skin, excess fat bulging, poor lymphatic drainage, or unrealistic expectations are not ideal candidates for tear trough fillers.

How to fix botched under-eye fillers?

Mild issues may resolve with time or massage, while more severe cases require hyaluronidase, medical intervention, or referral to a specialist.

What is the best age to get under-eye fillers?

There’s no set age, but most candidates are in their 30s to 50s. It depends on genetics, volume loss, and skin condition, not age alone.

Why are my under-eye circles worse after fillers?

Overfilling, incorrect depth, or using the wrong filler can accentuate shadows or puffiness, making the under-eye area appear worse.

How much do eye fillers cost?

The cost of under-eye fillers varies depending on the injector’s expertise, geographic location, clinic setting, and the product used. Prices are typically consistent with premium aesthetic procedures and often reflect the complexity of treating the tear trough area.

How to get rid of bad under-eye fillers?

For hyaluronic acid fillers, the standard correction approach is the injection of hyaluronidase to enzymatically dissolve the product. Selection of dilution, dose, and injection depth should align with the type and extent of complication. 

References:

1. Foster J, Aakalu VK, Freitag SK, Yen MT, Kim SJ, Wladis EJ, et al. Vision-threatening complications of soft tissue fillers: A report by the American Academy of Ophthalmology. Ophthalmology. Published online March 31, 2025. https://www.aaojournal.org/article/S0161-6420(25)00074-0/fulltext
2. Trinh LN, McGuigan KC, Gupta A. Delayed complications following dermal filler for tear trough augmentation: A systematic review. Facial Plast Surg. 2021;38(1). doi:10.1055/s-0041-1736390. https://www.researchgate.net/publication/355432973_Delayed_Complications_following_Dermal_Filler_for_Tear_Trough_Augmentation_A_Systematic_Review
3. Tran AQ, Lee WW. Vision loss and blindness following fillers. J Dermatol Skin Sci. 2021;1(1). doi:10.29245/2767-5092/2021/1.1134. https://www.dermatoljournal.com/articles/vision-loss-and-blindness-following-fillers.html
4. Nunez K. Undereye tear trough filler: What you should know. Healthline. Updated June 28, 2023. Accessed July 7, 2025. https://www.healthline.com/health/beauty-skin-care/tear-trough-filler

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Disclaimer:

This article is intended for licensed medical professionals. All protocols, dosages, and treatment insights referenced herein are based on published literature. The content is not intended to encourage application, diagnosis, or self-treatment of unlicensed individuals, and should not be used as a substitute for the clinical judgment of a qualified healthcare provider.

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