10 Tear Trough Filler Side Effects And How To Treat Them

Considering tear trough filler or worried about what you’re seeing after treatment? The under‑eye is a delicate, vessel‑rich area, so some swelling and bruising are common and usually short‑lived. But late‑night Googling can make it hard to tell what’s normal and what needs attention. If you’re noticing puffiness, a bluish hue, small lumps, asymmetry or anything more worrying like severe pain or vision changes, you’ll want clear guidance on how likely these issues are, how long they last, what you can safely do at home—and when to seek urgent help.

This guide sets out 10 possible tear trough filler side effects in plain English—bruising, swelling (including delayed/lymphatic), Tyndall effect, malar oedema, infection and biofilm, allergy, persistent lumps or migration, asymmetry, vascular occlusion and visual changes, and granuloma. For each, you’ll find signs and symptoms, likelihood and duration, practical self‑care, how we manage it in clinic at Wigmore Smiles & Aesthetics, and red‑flag symptoms that require urgent assessment. Use it to make an informed decision before treatment, or to navigate recovery with confidence. First up: bruising and haematoma.

1. Bruising and haematoma — prevention at Wigmore Smiles & Aesthetics

Bruising is the most common of all tear trough filler side effects. It happens when tiny under‑eye vessels are punctured during treatment; a haematoma is simply a larger, deeper collection of blood. Both look dramatic but are usually temporary and self‑resolving.

What it is

A bruise is superficial bleeding that shows as purple, blue or yellow discolouration. A haematoma is a firmer, more localised swelling caused by pooled blood beneath the skin.

Signs and symptoms

Expect local tenderness, colour change and mild puffiness. A haematoma tends to feel fuller or rubbery and can appear quickly in the first hours after treatment.

How likely is it and how long it lasts

Bruising is common and expected; most improves within 48–72 hours and fades over 7–14 days. Haematoma is less common but typically settles over 1–2 weeks as your body reabsorbs blood.

What you can do at home

Simple steps speed recovery and reduce visibility while you heal.

• Cool compresses: 10 minutes on/off for the first 48 hours.

• Sleep elevated: Two pillows to minimise pooling.

• Avoid heat, alcohol and strenuous exercise for 24–48 hours.

• Pause non‑essential blood‑thinning supplements (only if safe; don’t stop prescribed medicines without GP advice).

• Topicals: Arnica gel/cream may help the appearance.

How we treat it in clinic

Our focus is prevention and prompt support if it happens.

• Prevention first: We favour micro‑cannula where appropriate, minimal entry points, slow, precise placement and pre‑cooling.

• Aftercare plan: Clear do’s/don’ts and check‑ins.

• Assessment if pronounced: We examine to exclude haematoma under pressure or any vascular concern; emergency protocols (including hyaluronidase availability) are in place if needed.

When to seek urgent help

Contact us urgently for severe or escalating pain, skin blanching or mottling, dusky colour changes, spreading numbness, vision changes, or rapidly increasing tight swelling. If bruising worsens or hasn’t started to improve after a week or two, arrange a review.

2. Swelling (early, delayed, and lymphatic)

Some swelling is one of the most expected tear trough filler side effects. Early swelling comes from injection trauma and the filler drawing water; delayed or lymphatic swelling relates to how the product sits in a lymph‑sensitive area and, in some people, can show up weeks or even years later as puffiness or “bags”.

What it is

Early oedema is a short‑term fluid response after treatment. Delayed or lymphatic swelling happens when filler disrupts drainage or is too hydrophilic for the region, sometimes presenting as malar bags/festoons on the upper cheek.

Signs and symptoms

Typical signs are soft puffiness, a feeling of fullness and morning worsening that eases through the day. Delayed/lymphatic swelling looks like persistent under‑eye or cheekbone puffiness; it’s usually not hot or red. Redness, heat and throbbing pain suggest infection rather than simple oedema.

How likely is it and how long it lasts

Mild early swelling is common and usually improves within 48–72 hours, with the under‑eye settling over 1–2 weeks. Persistent swelling beyond four weeks is less common and may reflect product choice, volume, depth, or lymphatic sensitivity; delayed swelling can occur weeks to months later, and has been reported even years after older fillers.

What you can do at home

Simple measures help most early swelling settle smoothly.

• Cool compresses: Short, gentle cooling for the first 48 hours.

• Head elevation: Sleep on two pillows; avoid face‑down positions.

• Avoid heat, alcohol and strenuous exercise for 24–48 hours.

• Go easy on salt and keep hydrated.

• Hands off: Avoid rubbing; very gentle fingertip smoothing only if advised.

How we treat it in clinic

We first confirm the pattern and cause: product type, placement, volume and lymphatic status. Most cases need reassurance and follow‑up; if swelling persists beyond four weeks or shows a lymphatic pattern, we may recommend carefully dissolving hyaluronic acid filler with hyaluronidase and, if re‑treating later, using a tear‑trough‑appropriate product in conservative volumes.

When to seek urgent help

Contact us immediately for severe or escalating pain, skin blanching or mottling, dusky discolouration, rapidly increasing tightness, vision changes, or if swelling becomes red, hot and tender or you develop fever. These can indicate vascular compromise or infection and need urgent assessment.

3. Tyndall effect (bluish hue under the skin)

Of all tear trough filler side effects, the Tyndall effect is one of the most distinctive—and most often mistaken for a stubborn bruise. It’s not dangerous, but it is cosmetic and won’t fade like a bruise does. The good news: it’s fixable when identified correctly.

What it is

A light‑scattering phenomenon from hyaluronic acid filler placed too superficially, causing a blue‑grey discolouration under the thin under‑eye skin. It’s different to bruising and typically reflects product depth or choice rather than injury.

Signs and symptoms

You’ll notice a cool blue/grey tint that lingers beyond the usual 7–14‑day bruise window, often more obvious in daylight or flash photos. The skin feels normal (not hot or tender) and the area may be soft rather than lumpy.

How likely is it and how long it lasts

It’s an uncommon outcome when appropriate technique and product are used. Unlike bruising, it tends to persist until the superficially placed filler is dissolved or naturally degrades (which can take many months).

What you can do at home

While you’re deciding next steps, simple measures can camouflage the hue.

• Colour‑correct: Peach/orange concealer to neutralise blue tones.

• Protect from sun/heat: Reduces vascular flush that makes it look worse.

• Hands off: Don’t massage firmly—this won’t “push it deeper”.

• Wait a beat: If treatment was very recent, give 2–4 weeks to exclude a fading bruise.

How we treat it in clinic

We confirm it’s true Tyndall effect (not bruise or infection), then plan conservative correction.

• Targeted hyaluronidase: Small, precise doses to dissolve superficial filler, often in stages.

• Re‑treat later if needed: Using a tear‑trough‑appropriate HA, minimal volumes, correct depth/plane and careful technique (often cannula).

When to seek urgent help

Bluish colour alone is not an emergency. Seek urgent assessment if you also develop severe or escalating pain, skin blanching/mottling, a cold or dusky patch, rapidly increasing tight swelling, redness/heat with fever, or any visual changes—these are red flags for vascular compromise or infection.

4. Malar oedema and festoons (cheek puffiness)

Among tear trough filler side effects, malar oedema is the one that most often gets mistaken for “eye bags”. It’s a fluid‑related puffiness over the cheekbone that can appear soon after treatment or be delayed. It’s usually fixable, but it needs the right diagnosis and a tailored plan.

What it is

Malar oedema is localised swelling in the malar (cheekbone) area caused by fluid retention around filler or disrupted lymphatic drainage. Festoons are more bag‑like, drapey swellings on the upper cheek. Both can be influenced by filler choice, depth and volume.

Signs and symptoms

Cheekbone puffiness that’s soft to touch, often worse in the morning and easing through the day. The skin isn’t typically hot or red, and there may be a shadowed, puffy look in photos. It may occur on one or both sides.

How likely is it and how long it lasts

It’s relatively rare in skilled hands. Early puffiness usually settles in 1–2 weeks. Persistent swelling beyond four weeks may reflect product choice, volume or lymphatic sensitivity. Delayed cases can occur weeks to months later, and have been reported even years after older fillers.

What you can do at home

Start with conservative measures and monitor change over days, not hours.

• Cool compresses (first 48 hours): 10 minutes on/off.

• Sleep elevated: Two pillows; avoid face‑down positions.

• Avoid heat, alcohol and hard exercise for 24–48 hours.

• Reduce salt and stay hydrated.

• Hands off: Don’t rub or firmly massage the area.

How we treat it in clinic

We assess pattern, timing and product factors, and exclude infection. If swelling persists beyond four weeks or shows a lymphatic pattern, dissolving hyaluronic acid with targeted hyaluronidase is often effective. If re‑treating later, we use tear‑trough‑appropriate filler, conservative volumes and correct depth to minimise recurrence.

When to seek urgent help

Seek urgent assessment for severe or escalating pain, skin blanching or mottling, a dusky/cold patch, rapidly increasing tight swelling, vision changes, or if the area becomes red, hot and tender or you develop fever—these are red flags for vascular compromise or infection.

5. Infection and biofilm

True infection after under‑eye filler is uncommon, but it matters because it needs prompt, professional care. Most issues are mild bruising or swelling; infection shows a different pattern. You may also hear the term “biofilm” used for rare, delayed, low‑grade infections that can present as tender lumps months after treatment.

What it is

An infection happens when bacteria enter the injection site, usually presenting within the first couple of weeks. “Biofilm” refers to a suspected low‑grade bacterial contamination that can trigger recurrent inflammation around the filler.

Signs and symptoms

Look for redness that spreads, warmth, increasing tenderness or throbbing pain, and sometimes discharge or a boil‑like spot. Fever or feeling unwell can occur in more significant infections. By contrast, simple post‑treatment swelling isn’t hot or increasingly painful.

How likely is it and how long it lasts

It’s rare in experienced hands and when hygiene protocols are followed. Acute infections typically appear within two weeks. With correct treatment they settle, though nodules from delayed reactions can persist without targeted management.

What you can do at home

Act early and avoid home “fixes”.

• Keep it clean: Gentle cleansing; avoid makeup over inflamed skin.

• Do not squeeze or pierce any lumps or spots.

• Avoid heat and strenuous exercise until reviewed.

• Do not self‑start leftover antibiotics; seek assessment.

How we treat it in clinic

We assess urgently to confirm infection versus inflammation. Management may include prescription antibiotics and close review. If pus is present, appropriate drainage and swabs may be arranged. Where filler is acting as a focus, we may recommend dissolving hyaluronic acid with hyaluronidase once it’s safe to do so, and we always rule out red‑flag vascular issues.

When to seek urgent help

• Rapidly worsening redness, heat, and swelling

• Severe, escalating pain or a tense, tight feeling

• Discharge/abscess, fever, or feeling unwell

• Skin blanching/mottling, dusky colour, numbness, or vision changes

These need same‑day assessment to exclude vascular compromise or significant infection.

6. Allergic reactions and hypersensitivity

True allergy to hyaluronic acid tear trough filler is rare, but it can happen and ranges from mild, local itching or swelling to more dramatic reactions. Hypersensitivity can also be delayed—appearing days to a couple of weeks after treatment—so don’t dismiss new redness or swelling just because the first few days were smooth.

What it is

An immune response to the filler material (or, less commonly, contamination at the site) that triggers local inflammation. Immediate reactions present within hours to days; delayed reactions can develop up to two weeks later.

Signs and symptoms

Localised redness, itching, hives‑like bumps, swelling or warmth around the injection sites. In more significant reactions, there may be pronounced facial puffiness. Severe swelling with breathing difficulty is a medical emergency.

How likely is it and how long it lasts

With modern hyaluronic acid fillers, allergic reactions are uncommon. Mild cases often settle within a few days; delayed hypersensitivity may rumble on without targeted care and needs assessment.

What you can do at home

Start with calm, simple measures and monitor closely.

• Cool compresses: Short, gentle cooling to ease itch and puffiness.

• Hands off: Avoid rubbing, hot environments and strenuous exercise.

• Pause new skincare/makeup on the area until reviewed.

• Seek advice promptly if symptoms don’t improve in 24–48 hours.

How we treat it in clinic

We examine to confirm allergy versus infection or simple oedema. Management is individualised and may include reassurance, structured follow‑up, and, where persistent or bothersome, dissolving hyaluronic acid with carefully dosed hyaluronidase. If infection is suspected, we treat that first. Red‑flag features trigger our urgent pathways.

When to seek urgent help

• Severe or rapidly increasing swelling, especially around eyes or lips

• Difficulty breathing, dizziness, or widespread hives

• Severe pain, skin blanching/mottling, or vision changesThese require same‑day urgent assessment.

7. Persistent lumps, nodules, and migration

Small bumps after under‑eye filler are common in the first days as tissue settles. If a lump hangs around or appears later, it may be a filler bolus, a fibrotic nodule, or product that has migrated. Most are sortable, but the cause dictates the fix.

What it is

“Lumps” can be soft product sitting in one spot, firmer nodules from tissue reaction, or filler that has shifted from where it was placed (migration). Superficial placement may also show a bluish tint (Tyndall effect), which is cosmetic rather than infectious.

Signs and symptoms

You may feel a pea‑sized bump that’s smooth or slightly firm. It’s usually not hot or increasingly painful. A blue‑grey cast suggests superficial filler; redness, heat, throbbing or discharge points more to infection than a simple nodule.

How likely is it and how long it lasts

Early unevenness often evens out within 1–2 weeks. Persistent lumps beyond four weeks are less common. In studies of delayed dermal filler issues, lumps/nodules made up around a quarter of delayed complications, with swelling the most frequent. Some delayed nodules need targeted management.

What you can do at home

• Give it time: Wait 2–4 weeks for natural settling if treatment was recent.

• Hands off: Don’t squeeze; gentle smoothing only if we’ve advised it.

• Cool briefly: Light cooling in the first 48 hours can help.

• Watch for red flags: Heat, redness, worsening pain or fever need review.

How we treat it in clinic

We examine to confirm nodule versus Tyndall, migration or infection. Most aesthetic lumps respond to precise, staged hyaluronidase to dissolve hyaluronic acid. If re‑treating later, we use tear‑trough‑appropriate filler, conservative volumes and correct depth/plane to minimise recurrence.

When to seek urgent help

• Severe or escalating pain, skin blanching/mottling, dusky or cold skin

• Vision changes or rapidly enlarging, tight swelling

• Red, hot, tender lump, discharge, fever or feeling unwell These can indicate vascular compromise or infection and require same‑day assessment.

8. Asymmetry and over/under-correction

Of all tear trough filler side effects, asymmetry is one of the most common early worries. Because the under‑eye tissues and lymphatics differ from side to side, minor unevenness—especially in the first couple of weeks—is normal and often settles as swelling resolves.

What it is

Asymmetry is a visible difference between sides after treatment. Over‑correction means too much volume or projection; under‑correction means the trough still looks hollow. Many clinicians intentionally under‑correct initially to avoid puffiness in this sensitive area.

Signs and symptoms

One side may look fuller or flatter, with different shadowing in photos. Over‑correction can show persistent puffiness or a ridge; under‑correction looks like residual hollowing. There’s usually no heat or increasing pain.

How likely is it and how long it lasts

Mild early asymmetry is common and typically improves as swelling settles (most swelling improves by 48–72 hours and the area refines over 1–2 weeks). True asymmetry persisting beyond 2–4 weeks may reflect product placement or volume and merits review.

What you can do at home

• Stay patient for 2–4 weeks; take like‑for‑like photos in daylight.

• Sleep with your head elevated; avoid vigorous exercise and heat for 48 hours.

• Don’t massage firmly unless we’ve advised it.

How we treat it in clinic

We review at 2–4 weeks in consistent lighting. Under‑correction is usually refined with small, precise top‑ups. Over‑correction is addressed with micro‑doses of hyaluronidase to soften excess volume; if needed, we dissolve and re‑treat later using tear‑trough‑appropriate filler in conservative, staged amounts.

When to seek urgent help

Sudden, severe or escalating pain, skin blanching/mottling, a cold/dusky patch, rapidly increasing tight swelling, redness/heat with fever, or any visual changes. These are red flags for vascular compromise or infection and need same‑day assessment.

9. Vascular occlusion and visual changes (blindness risk)

This is the rare but serious complication most people worry about. A vascular occlusion happens when filler enters or compresses a blood vessel, restricting blood flow to the skin—or, in very rare cases, to the eye. Untreated, it can lead to tissue damage, and exceptionally, permanent vision loss has been reported after facial fillers.

What it is

During injection, filler can inadvertently enter a vessel or compress it from the outside. In the under‑eye/cheek area, this can starve the skin of oxygen; if the ocular blood supply is affected, rapid assessment is critical to protect sight.

Signs and symptoms

Symptoms usually start during or soon after treatment. Skin signs differ from normal bruising or swelling and need immediate action.

• Sudden, severe or escalating pain in the area

• Skin blanching/pallor or mottled purple patches (livedo)

• Cool, tight skin with increasing firmness

• Rapidly worsening swelling or numbness

• Any visual change: blurred/dim vision, “grey curtain”, loss of vision, new floaters, or eye pain

How likely is it and how long it lasts

Fortunately, it’s rare—especially in experienced hands—but it’s time‑sensitive. Skin changes can evolve over minutes to hours. Visual symptoms are an emergency and require same‑day, immediate management.

What you can do at home

Don’t wait to see if it settles—speed matters.

• Contact the clinic immediately for urgent instructions.

• If you can’t reach us promptly and you have visual symptoms, go to A&E.

• Do not apply heat or massage firmly unless a clinician advises you in real time.

• Do not drive yourself if your vision is affected.

How we treat it in clinic

We activate our emergency pathway without delay. That includes immediate assessment and targeted hyaluronidase to dissolve hyaluronic acid filler, with close monitoring of skin perfusion. If there are any visual symptoms, we arrange urgent ophthalmology input at once. Early treatment offers the best chance of recovery.

When to seek urgent help

• Any vision change (blurring, dimming, “curtain”, sudden vision loss) or eye pain

• Severe or escalating pain, skin blanching/mottling, or a cold/dusky patch

• Rapidly increasing, tight swelling or spreading numbness If these occur, contact us immediately; if vision is affected, go straight to A&E or call 999.

10. Granuloma formation (delayed inflammatory reaction)

Of the tear trough filler side effects that appear long after treatment, granulomas are among the rarest. They’re not a “bad bruise”; they’re a specific immune reaction that can show up months to years later and needs proper diagnosis rather than guesswork or forceful massage.

What it is

A granuloma is a localised cluster of immune cells formed around material the body perceives as foreign. With modern hyaluronic acid fillers, this reaction is extremely unlikely and is more associated with non‑biodegradable fillers.

Signs and symptoms

Firm, often pea‑sized bumps that are tender or achy and don’t behave like early post‑treatment swelling. The skin usually looks normal, but occasional redness can occur during “flare” phases. Unlike Tyndall effect, there’s no blue‑grey hue unless filler is superficial as well.

How likely is it and how long it lasts

Granulomas are rare with hyaluronic acid and tend to develop several months to years after injection. Without targeted management, they can persist or fluctuate in size. Delayed lumps more commonly represent simple nodules; true granulomas are a smaller subset.

What you can do at home

• Hands off: Don’t squeeze or try to “pop” the lump.

• Note timing: Keep a brief symptom diary (size, tenderness, triggers).

• Gentle cooling: Short, cool compresses can ease tenderness.

• Pause new skincare/makeup on the area until reviewed.

• Book a review: Especially if the lump persists beyond two weeks or is worsening.

How we treat it in clinic

We assess to distinguish granuloma from simple nodule, migration or infection. Management is individualised and may include reassurance with structured follow‑up and, where appropriate, targeted hyaluronidase to dissolve hyaluronic acid filler. If infection is suspected, we address that first before any dissolving. Future treatment plans use tear‑trough‑appropriate products in conservative, staged amounts.

When to seek urgent help

• Red, hot, increasingly painful swelling, discharge, fever or feeling unwell

• Severe or escalating pain, skin blanching/mottling, dusky or cold skin

• Any visual change (blurred/dim vision, “curtain”, eye pain) These are red flags for infection or vascular compromise and need same‑day assessment.

Key takeaways and next steps

Most under‑eye filler issues are mild and short‑lived; swelling and bruising improve within days and the area refines over 1–2 weeks. Serious problems are uncommon—what matters is knowing the red flags and having a clinic that can assess and act quickly. If something doesn’t look or feel right, don’t wait.

• Normal vs not: Mild puffiness, tenderness and small bumps early on are common. Severe pain, skin blanching/mottling, a dusky/cold patch, fever, or any visual change need same‑day help.

• Home care basics: Cool compresses, head elevation, no heat/alcohol/strenuous exercise for 24–48 hours, and hands off the area.

• Timeline: Reassess photos at 2–4 weeks before judging results. Persistent swelling, Tyndall hue or lumps beyond four weeks—book a review.

• Fixes exist: Hyaluronidase can safely dissolve HA filler when needed; staged, conservative re‑treatment prevents recurrence.

• Prevention: Choose appropriate products, precise technique, and conservative volumes.

If you’d like tailored advice or a calm, expert review, book a consultation with Wigmore Smiles & Aesthetics.