Tear Trough Filler Risks: 10 Complications & Treatments

Thinking about under‑eye (tear trough) filler but unsure what could go wrong? You’re not alone. The tear trough is a delicate, high‑stakes area: while most people experience nothing more than short‑lived bruising or swelling, others worry about puffiness that won’t settle, blue‑grey discolouration (Tyndall effect), lumps, asymmetry, or infection — and, in very rare cases, vascular problems that threaten skin or vision. The challenge is knowing how likely these issues are, how to spot them early, and what can be done to prevent or fix them if they occur.

This guide sets out a clear, clinical view of tear trough filler risks. We’ll cover 10 potential complications in plain English — what they are, how common they are, early warning signs, proven prevention strategies, and treatment options (including dissolving hyaluronic acid filler with hyaluronidase) — plus when to seek urgent medical help. You’ll also see how a medically led approach at Wigmore Smiles & Aesthetics reduces risk and supports safe reversal where needed. Most problems are manageable when recognised promptly; use this as a practical checklist before, during and after treatment to make confident, informed decisions.

1. Medically led tear trough filler at Wigmore Smiles & Aesthetics (risk reduction and reversal)

A medically led approach is the single biggest factor in lowering tear trough filler risks. At Wigmore Smiles & Aesthetics your treatment is clinician‑planned, safety‑checked and fully reversible with hyaluronidase (hyalase) if needed, so problems can be managed promptly rather than watched and worried about.

What it is

We assess your anatomy, skin thickness and under‑eye fat pads to confirm suitability, then use hyaluronic acid filler formulated for the tear trough, meticulous sterile technique, and conservative dosing. Where appropriate, we use a cannula to reduce vessel injury and bruising, and stage treatment to avoid overfilling.

How common it is

Most patients get mild, short‑lived swelling or bruising that settles within 1–2 weeks. Uncommon issues include Tyndall effect (blue‑grey hue), persistent puffiness or small lumps. Serious complications such as infection or vascular occlusion are rare in experienced hands, and vision‑threatening events are very rare but reported.

Warning signs

Early recognition changes outcomes. Contact us urgently if you notice:

• Severe, escalating pain, skin blanching or mottled purple patches

• Vision changes, new headache behind the eye, dizziness

• Rapidly worsening redness, heat or discharge from injection sites

• Blue‑grey discolouration, hard or tender lumps, or swelling that doesn’t improve

How to prevent it

Good prevention starts before the first syringe:

• Careful candidate selection: very thin skin, excess fat/skin or very deep troughs may need alternatives.

• Right product and plane: fillers suited to the under‑eye reduce puffiness risk.

• Technique matters: cannula use, small volumes, slow placement.

• Pre/post care: pause blood‑thinning supplements where safe, avoid alcohol/heat and strenuous exercise, use ice in the first 48 hours. Never use needle‑free devices for fillers.

Treatment options

• Bruising/swelling: cold compresses, head elevation, time.

• Tyndall effect/puffiness/asymmetry/lumps: targeted dissolving with hyaluronidase.

• Infection: prompt medical assessment, antibiotics, and dissolving if indicated.

• Allergy/granuloma: medical management; may require dissolution.

• Suspected vascular occlusion: immediate high‑dose hyaluronidase and urgent care.

When to seek medical help

Seek same‑day help for vision symptoms, severe pain, skin blanching/mottling, or rapidly spreading redness/fever. Contact us if bruising/redness worsens after 48–72 hours, if you develop painful/red lumps, or if swelling persists beyond about four weeks.

2. Bruising and haematoma after tear trough filler

Bruising is the most common short‑term issue after under‑eye filler. The area is highly vascular, so tiny vessels can be pierced during injection. A haematoma is a larger, deeper collection of blood that can make the under‑eye look darker or feel tender but usually settles with time.

What it is

Bruising is superficial discolouration from blood under the skin. A haematoma is a more substantial bleed that may feel firm or puffy. Both are typically self‑limiting and not harmful.

How common it is

Common and expected. Most bruising/swelling improves within 48–72 hours and fades over 1–2 weeks for the majority of patients.

Warning signs

Look out for:

• Rapidly expanding swelling or severe pain/pressure

• Worsening bruising after 72 hours rather than gradual fade

• Redness, heat or discharge (infection signs)

• Skin blanching/mottling or vision changes (urgent red flags)

How to prevent it

• Technique: cannula use, slow placement, small volumes.

• Cold compresses: before and after treatment to constrict vessels.

• Medication/supplements: pause blood‑thinners where medically safe and approved by your prescriber.

• Post‑care: avoid vigorous exercise, alcohol and heat for a few days; sleep on your back with the head elevated.

Treatment options

• Cold packs intermittently for 24–48 hours; keep the head elevated.

• Topicals: arnica gel/cream may help with bruising and swelling.

• Time: most bruises resolve within 1–2 weeks. Larger haematomas may need review but usually settle without intervention.

When to seek medical help

Same‑day if you have severe pain, skin blanching/mottling, rapidly spreading swelling, fever, or any vision change. Contact the clinic if bruising worsens after 72 hours, a firm tender mass persists, or discolouration hasn’t improved after about two weeks.

3. Swelling and oedema after tear trough filler

Some swelling is expected after under‑eye filler as the tissues react to needle or cannula passes and the hydrophilic nature of hyaluronic acid. Oedema ranges from mild puffiness that settles quickly to delayed, water‑retaining swelling or malar oedema that sits over the cheekbone.

What it is

Swelling is fluid accumulation in the treated tissues; malar oedema is a persistent, often morning‑worse puffiness in the cheek/under‑eye junction. It can be aggravated by product choice, volume, placement depth, or disrupted lymphatic drainage.

How common it is

Mild swelling is typical and improves over 48–72 hours, with most settling within 1–2 weeks. If puffiness persists beyond about four weeks, filler choice/placement or volume may be the cause and review is advised.

Warning signs

Most swelling is harmless, but act if you notice concerning features.

• Progressive or persistent puffiness beyond several weeks

• Morning‑worse cheek swelling suggestive of malar oedema

• Redness, heat, discharge or fever indicating possible infection

• Severe pain or skin blanching/mottling (urgent vascular red flags)

How to prevent it

Smart planning and technique greatly reduce tear trough filler risks.

• Use under‑eye‑appropriate HA fillers and conservative volumes

• Correct plane and slow placement, often with a cannula

• Post‑care: ice in the first 48 hours; avoid alcohol, heat and strenuous exercise; sleep head‑elevated

Treatment options

Most cases need simple measures; persistent oedema may need active management.

• Cold compresses and elevation, then time for natural resolution

• Hyaluronidase dissolution for Tyndall‑like hue, overfill or malar oedema

• Antibiotics and clinical review if infection is suspected; dissolve filler if indicated

When to seek medical help

Contact the clinic if swelling worsens after 72 hours or hasn’t improved by 2 weeks; book review if puffiness persists beyond four weeks. Seek same‑day help for severe pain, skin blanching/mottling, rapidly spreading redness, fever, or any change in vision.

4. Tyndall effect (blue-grey discolouration)

A blue‑grey hue under the eyes after filler can be alarming, but it’s usually a technical issue rather than a dangerous one. The Tyndall effect happens when hyaluronic acid (HA) sits too superficially, scattering light and tinting the skin — and it’s fixable.

What it is

The Tyndall effect is a visible blue‑grey discolouration caused by superficially placed HA gel. It may be accompanied by slight translucency or puffiness and, unlike a bruise, it doesn’t go through colour‑change stages or fade quickly on its own.

How common it is

It’s uncommon compared with routine bruising or short‑term swelling and is seen more when unsuitable products are used or filler is placed too close to the surface.

Warning signs

If you notice colour change, check for persistence and pattern.

• Blue‑grey tint at or near the injection track

• Translucent swelling that looks “watery”

• No improvement after the usual 1–2 weeks

How to prevent it

Depth, product and dosing matter most.

• Inject at the appropriate depth for the under‑eye

• Choose tear‑trough‑suitable HA rather than generic fillers

• Use conservative volumes, often in staged sessions

• Favour precise technique, including cannula where indicated

Treatment options

The definitive fix is dissolving the superficial gel.

• Targeted hyaluronidase to break down the HA

• Staged sessions if large volumes were placed

• Re‑treat later at the correct depth only if still indicated

When to seek medical help

Book a review if the blue‑grey hue persists beyond about two weeks or bothers you cosmetically. Seek same‑day help if discolouration is accompanied by severe pain, skin blanching/mottling, rapidly spreading redness/heat, fever, or any change in vision.

5. Malar oedema and persistent puffiness

Among tear trough filler risks, persistent puffiness — often called malar oedema — is one of the most frustrating. It presents as swelling over the cheekbone/under‑eye junction and is typically linked to product choice, volume or placement, and sometimes disruption of lymphatic drainage.

What it is

Malar oedema is fluid retention and swelling in the malar (cheekbone) area after under‑eye filler. It can follow filler that is too hydrophilic, too superficial, or placed in unsuitable candidates, and may persist rather than settling like routine post‑treatment swelling.

How common it is

Persistent malar oedema is relatively rare in experienced hands, but clinics are seeing more cases in patients who had older fillers or unsuitable placement. More broadly, delayed swelling is a recognised filler complication.

Warning signs

Most early puffiness improves quickly; ongoing swelling deserves review.

• Puffiness over the cheekbone/tear trough that persists beyond the usual 1–2 weeks

• Soft, watery swelling rather than a simple bruise

• No improvement by around four weeks, or return of swelling after initial settling

• Any redness, heat, pain or discharge (consider infection)

How to prevent it

• Choose tear‑trough‑appropriate HA fillers with suitable hydrophilic properties

• Use conservative volumes and stage treatments

• Place at the correct depth/plane, often with a cannula

• Select candidates carefully; avoid treating where excess fat/skin or anatomy makes swelling likely

• Avoid stacking on old product without assessing and, if needed, dissolving first

Treatment options

• Early measures: head elevation and cold compresses while monitoring

• Targeted hyaluronidase to dissolve HA causing puffiness; may require staged sessions

• Assess for infection where redness/heat/discharge are present; treat and dissolve if indicated

• Consider alternatives to filler for unsuitable candidates in future

When to seek medical help

Arrange a review if swelling hasn’t improved by 2 weeks or persists beyond about 4 weeks. Seek same‑day help for severe pain, skin blanching or mottling, rapidly spreading redness/fever, or any vision change.

6. Infection at the injection site

Among tear trough filler risks, true infection is uncommon but important to recognise early. It occurs when bacteria enter through injection points, leading to inflammation that can worsen over several days rather than improve. Prompt, medically led assessment keeps outcomes straightforward and reduces the chance of secondary problems.

What it is

A post‑injection infection is a bacterial contamination of the skin or deeper tissues at the under‑eye entry points, causing redness, heat, swelling and pain. It can appear within days and occasionally later.

How common it is

Infections are rare in experienced hands that follow strict sterilisation protocols. Both medical sources and specialist clinics describe them as unusual but possible.

Warning signs

Most early redness fades; infection tends to escalate.

• Worsening redness, heat and swelling after 48–72 hours

• Increasing pain/tenderness, especially to light touch

• Discharge or pus from entry points

• Fever or feeling unwell

• Red, painful lumps rather than simple soft puffiness

How to prevent it

Meticulous technique and aftercare lower risk.

• Choose trained medical providers who use proper skin disinfection and sterile equipment

• Use approved injection methods (avoid needle‑free devices for fillers)

• Follow aftercare: keep sites clean, avoid unnecessary touching, and adhere to clinic guidance

Treatment options

Act early; most cases respond well.

• Prompt clinical assessment and prescribed antibiotics when indicated

• Targeted hyaluronidase to dissolve HA if the filler is contributing to inflammation

• Close follow‑up to ensure resolution and decide on any later corrective work

When to seek medical help

Same‑day review for rapidly worsening redness/heat, increasing pain, discharge, fever, or swelling that intensifies after 72 hours. Treat as urgent if accompanied by skin blanching/mottling or any change in vision.

7. Allergic and granulomatous reactions

True allergy and granuloma formation are uncommon tear trough filler risks, but they matter because they can appear later and linger. Allergic reactions tend to show as redness, itching or swelling soon after treatment or in a delayed fashion; granulomas are small, firm inflammatory lumps that can develop months to years after injection, especially with non‑biodegradable fillers.

What it is

An allergic reaction is your immune system responding to the filler with swelling, redness, itching or a rash; severe cases can involve significant facial swelling or breathing difficulty. A granuloma is a localised inflammatory nodule where the body walls off material it perceives as foreign; with modern hyaluronic acid (HA) fillers this is rare.

How common it is

Allergic reactions to HA fillers are reported but uncommon, and granulomas are extremely unlikely with modern HA gels. Delayed granulomas are more associated with permanent/non‑biodegradable products.

Warning signs

Most normal post‑procedure changes improve quickly; allergy/granuloma patterns persist or escalate.

• Spreading redness, itching or swelling beyond 48–72 hours

• Severe or sudden swelling, hives, or difficulty breathing

• Red, tender or painful lumps that don’t settle

• Firm nodules appearing months after treatment

How to prevent it

Good screening and product choice lower risk.

• Use reputable, HA fillers suited to the under‑eye

• Avoid needle‑free devices for injection

• Share allergy history and previous reactions with your clinician

• Stage treatments with small volumes and review before adding more

Treatment options

Management depends on severity and timing.

• Medical assessment for any suspected allergy; treat symptoms and monitor closely

• Targeted hyaluronidase to dissolve HA contributing to persistent inflammation or nodules

• Treat coexisting issues (e.g., infection) where redness/heat/discharge are present

• Plan alternatives to filler in future if you’ve reacted

When to seek medical help

Treat as urgent if you develop severe facial swelling, breathing difficulty, dizziness, or rapidly worsening redness/heat. Arrange prompt review for spreading rash/itching beyond 72 hours, painful red lumps, or firm nodules that persist or appear months later.

8. Persistent lumps, nodules and biofilm

Lumps after tear trough filler range from small, soft irregularities to firm nodules. They may appear early (from product placement or clumping) or later (from inflammation). Causes include migration or clumping of filler, an inflammatory response to the gel, or sub‑optimal injection depth/technique. Clinicians sometimes use the term “biofilm” for long‑standing, intermittently inflamed lumps that may reflect low‑grade bacterial involvement and need medical assessment.

What it is

A persistent lump is a focal area you can see or feel after under‑eye filler. It may be painless and simply cosmetic, or red, tender and inflamed. “Biofilm‑type” nodules tend to flare, then settle, rather than resolving completely without treatment.

How common it is

Small, early irregularities are not unusual and often improve. Among delayed filler complications reported in the literature, lumps/nodules account for around a quarter of cases, highlighting the need for prompt review when they persist.

Warning signs

Not all lumps are equal; watch for features that suggest active problems.

• Red, hot, painful lumps that worsen after 48–72 hours

• Lumps that persist or enlarge beyond 2–4 weeks

• Intermittent flare‑ups of tenderness/redness (biofilm‑type pattern)

• Associated fever, discharge, or spreading redness

How to prevent it

Thoughtful planning and technique reduce the risk of nodules.

• Use tear‑trough‑appropriate HA and conservative, staged dosing

• Correct depth/plane and precise placement, often via cannula

• Meticulous asepsis and approved injection methods; avoid needle‑free devices

• Aftercare: avoid pressure/massage unless advised; keep sites clean

Treatment options

Management depends on appearance, timing and symptoms.

• Early, minor irregularities: clinic‑advised gentle massage and time

• Persistent cosmetic lumps or Tyndall‑like translucency: targeted hyaluronidase to dissolve HA

• Red/tender nodules: clinical assessment, consider antibiotics and dissolving the filler

• Re‑treatment later only if still indicated, using adjusted product/technique

When to seek medical help

Arrange prompt review for lumps that persist beyond two weeks, enlarge, or cause cosmetic concern. Seek same‑day help for painful red lumps, discharge, fever, rapidly worsening swelling, skin blanching/mottling, or any change in vision.

9. Asymmetry, migration and overfilling

Even in expert hands, perfect symmetry under the eyes is challenging. Subtle differences in anatomy and tissue response can leave one side looking fuller than the other. If technique or product choice is sub‑optimal, filler can look “puffy” (overfilled) or even shift from where it was placed (migration).

What it is

• Asymmetry: one under‑eye appears fuller or shaped differently.

• Overfilling: excessive volume or too‑superficial placement causing a puffy, unnatural contour.

• Migration: filler moves away from the intended plane/area, sometimes showing as a ledge or lumpiness nearby.

How common it is

Mild asymmetry is relatively common and often settles as swelling subsides. Aesthetic issues like lumpiness or movement can occur if filler is placed improperly; conservative, staged treatment makes them less likely.

Warning signs

Notice what persists after the usual healing window.

• Uneven fullness or a shelf‑like edge once swelling has settled (typically after 1–2 weeks)

• Under‑eye “pillow” look or persistent puffiness suggesting overfill

• New contour/lump in an adjacent area indicating possible migration

• Any redness, heat, pain or rapid change (consider infection or vascular issues)

How to prevent it

• Careful candidate selection and expectation setting

• Under‑eye‑appropriate HA, correct depth/plane, often cannula‑assisted

• Conservative dosing and staged sessions, re‑assess before adding more

• Strict aftercare: avoid pressure, rubbing and vigorous exercise early on

• Use approved injection methods; avoid needle‑free devices

Treatment options

• Wait and review at 2 weeks; some asymmetry is swelling‑related

• Clinic‑guided gentle moulding for minor irregularities

• Targeted hyaluronidase to reduce overfill or dissolve migrated product

• Micro‑top‑up on the under‑corrected side once tissues are settled

• Address any red flags first (infection/vascular concerns)

When to seek medical help

Book a review if unevenness or suspected migration persists beyond 2–4 weeks, or if the result looks unnaturally puffy. Seek same‑day help for severe pain, skin blanching/mottling, rapidly worsening redness/fever, or any change in vision.

10. Vascular occlusion and vision risk (retinal artery occlusion)

This is the rare but most serious of all tear trough filler risks. Vascular occlusion happens when filler enters or compresses a blood vessel, restricting blood flow to skin — and, in exceptionally rare cases, to the eye. Prompt recognition and immediate action are critical to protect skin and vision.

What it is

Vascular occlusion is a blockage or compression of a vessel by filler. In the skin it can threaten tissue (ischaemia/necrosis). If filler reaches vessels connected to the eye, a retinal artery occlusion can occur, which is a medical emergency because it can cause permanent vision loss.

How common it is

In experienced hands it’s rare; vision‑threatening events are very rare but reported in the literature and by medical sources. The risk underscores why under‑eye treatment must be delivered by trained clinicians who understand anatomy and emergency management.

Warning signs

Most routine post‑treatment changes improve; occlusion patterns escalate or alarm.

• Blanching/pale or mottled purple skin in the treated zone

• Severe, disproportionate pain or pressure

• New headache (especially behind the eye)

• Vision changes: blurring, shadow/field loss, double vision, or sudden loss

• Cool, dusky skin or tiny purple dots/patches near the site

How to prevent it

Reducing risk relies on expertise, technique and planning.

• Choose a medically trained injector with deep anatomical knowledge

• Use cannula where indicated, small doses and slow placement

• Select under‑eye‑appropriate HA fillers and correct depth/plane

• Avoid needle‑free devices for filler injections

• Have hyaluronidase ready and an emergency protocol in place

Treatment options

If occlusion is suspected, act immediately — minutes matter.

• Stop injecting and assess the area and symptoms

• Immediate high‑dose hyaluronidase to dissolve HA along the suspected vessel path

• Urgent escalation: same‑day emergency eye care if any vision symptom occurs

• Close monitoring and follow‑up to manage skin recovery and prevent secondary issues

When to seek medical help

Treat as an emergency. Seek same‑day urgent care immediately for any vision change, severe pain, skin blanching/mottling, rapidly worsening discolouration, or new severe headache. Contact the clinic urgently if symptoms are evolving or you’re unsure — do not wait to “see if it settles.”

Final thoughts

Under‑eye fillers can refresh a tired look, but only when risks are respected and managed. The take‑home is simple: most issues are mild and settle quickly; the uncommon ones are usually fixable when spotted early; the rarest complications demand immediate action. Choosing a medically led clinic that screens carefully, uses the right product and technique, and can safely dissolve HA on the spot is the biggest safety net you can give yourself.

If you’re considering treatment, come armed with questions, realistic goals and a plan for aftercare. We’ll assess your suitability, explain your personal risk profile and map out prevention and response steps before any syringe touches skin. For calm, clinician‑led tear trough care — including reversal if needed — book a consultation with Wigmore Smiles & Aesthetics. Flexible finance and online booking make it easy to start well and stay safe. Begin here: Wigmore Smiles & Aesthetics.