Short answer
The most common risks of tear trough filler are bruising, swelling and small lumps, which usually settle. Problems more specific to the under-eye area include a bluish tinge under thin skin, puffiness that can persist or appear months to years later, and visible irregularities. Blocked blood vessels and vision loss are rare but serious. Risk depends heavily on the anatomy of the under-eye area, the product and volume used, how deeply it is placed and the injector’s experience.
Key points
- A systematic review of 830 patients found no major complications, but the studies were small and at high risk of bias.
- Bruising and swelling rates varied widely between studies.
- A blue-grey tint (the Tyndall effect) is linked to filler placed too close to the surface.
- Swelling over the upper cheek (malar oedema) has been reported in up to 11% of tear trough cases.
- Hyaluronic acid filler can usually be dissolved if problems arise.
Why the under-eye area behaves differently
The tear trough is the groove running from the inner corner of the eye down and out across the upper cheek. The skin here is among the thinnest on the face and sits over little fat. That makes small amounts of filler more visible and swelling more noticeable.
Hyaluronic acid attracts water. EyeWiki, the American Academy of Ophthalmology’s reference, notes that swelling can stretch tissues and that late swelling may occur as the gel slowly breaks into smaller pieces that absorb more water1. This is one reason the under-eyes are less forgiving than the cheeks or lips.
The cause of the shadow also matters. A hollow from volume loss is different from bulging eye bags caused by fat pushing forward, loose skin, or fluid retention. Filler adds volume; it does not remove bags or tighten skin, and adding volume next to a bag can make puffiness look worse. Some people are better served by discussing eyelid surgery (blepharoplasty) or no treatment.
The risks, from common to rare
| Risk | What it looks like | What the evidence shows |
|---|---|---|
| Bruising | Purple or yellow marks, sometimes delayed | Reported in 2% to about 61% of patients across studies2 |
| Swelling | Puffiness in the days after treatment | Reported in 3% to 51% across studies2 |
| Lumps or irregularities | Bumps or uneven contour | From transient bumps settling in days to persistent irregularities in some series2 |
| Tyndall effect | Bluish or blue-grey tint under the skin | About 1% to 3% in several studies; linked to superficial placement25 |
| Malar oedema | Persistent swelling over the upper cheek, sometimes years later | Up to 11% of tear trough cases1 |
| Delayed nodules or migration | Lumps appearing weeks to years later | Delayed nodules in about 0.5% of hyaluronic acid treatments overall1 |
| Blocked blood vessel, vision loss | Pain, skin colour change, visual disturbance | Rare; tear trough-specific rates unknown14 |
Swelling over the upper cheek is the risk most particular to this area. EyeWiki reports that patients may present years after treatment, and that risk is reduced by limiting volume, choosing a suitable filler and placing it deep1.
Filler that moves away from where it was placed can also cause delayed lumps, and orbital problems from migrated filler may appear long after the procedure and be hard to link back to it1. Keeping a record of the product and date helps future clinicians.
The serious risks
The FDA describes unintentional injection into a blood vessel as the most concerning risk of any dermal filler, with reported tissue death, blindness and stroke3. Published vision-loss cases cluster around the nose, the area between the brows, the forehead and the nasolabial folds rather than the tear trough4, but the under-eye area is close to vessels supplying the eye, so the risk is not zero. How often it happens after tear trough filler specifically is Uncertain incidence.
How strong is the evidence?
A 2021 systematic review of nine studies and 830 patients treated with hyaluronic acid for tear trough deformity recorded no major complications and judged the procedure generally safe, with mostly self-limiting side effects2. However, the authors rated the included studies at high risk of bias, most were small or retrospective, and none compared filler with surgery2. Evidence on the safety profile is therefore Limited, and rare events are unlikely to show up in studies of this size.
What may reduce risk
- An assessment of why the under-eye looks hollow or dark before deciding on filler.
- Small volumes placed deep, as the review authors and EyeWiki both recommend12.
- A hyaluronic acid product, so that it can be dissolved; EyeWiki advises hyaluronidase should be on hand during treatment1.
- An injector with specific experience in the under-eye area and a plan for complications3.
When to seek medical advice
Seek immediate medical attention for unusual pain, vision changes, a white, grey or blue appearance of skin near the injection site, or signs of stroke during or shortly after treatment3. Vision loss after filler may come with eye pain or a gap in the field of vision1. Swelling or lumps that appear weeks or months later are not usually an emergency but should be checked by the treating clinician.
Common questions
Can tear trough filler make eye bags worse?
It can, particularly if puffiness is caused by fat or fluid rather than hollowing, or if the filler itself causes swelling over the upper cheek1.
Can a blue tint under the eyes be fixed?
Usually yes; options described include hyaluronidase to dissolve the filler, gentle massage and camouflage make-up1.
Why is my under-eye puffy months after filler?
Late puffiness can occur as hyaluronic acid absorbs water while it breaks down, or from filler migration or delayed nodules1. It needs assessment, and dissolving is one of the options.
Is filler safer than eyelid surgery?
It is less invasive, but no study in the main review compared the two directly2, and they suit different causes of under-eye change.
Bottom line
Most problems after tear trough filler are temporary, but the under-eye area is prone to visible lumps, a blue tint and persistent or late swelling, and rare vascular events are serious. The evidence is limited, so a careful diagnosis of what is causing the under-eye change matters as much as the choice of injector.
Related reading
- Dermal fillers
- Can Dermal Fillers Be Dissolved?
- What Are the Warning Signs of a Filler Blocking a Blood Vessel?
- What Is Blepharoplasty (Eyelid Surgery)?
Sources
- Barmettler A, Thuma T, et al. Complications of hyaluronic acid fillers. EyeWiki, American Academy of Ophthalmology; updated 2026. https://eyewiki.org/Complications_of_Hyaluronic_Acid_Fillers. Accessed 5 November 2026.
- D’Amato S, Fragola R, Bove P, et al. Is the treatment of the tear trough deformity with hyaluronic acid injections a safe procedure? A systematic review. Applied Sciences; 2021;11:11489. https://doi.org/10.3390/app112311489
- US Food and Drug Administration. Dermal fillers (soft tissue fillers). FDA. https://www.fda.gov/medical-devices/aesthetic-cosmetic-devices/dermal-fillers-soft-tissue-fillers. Accessed 5 November 2026.
- Beleznay K, Carruthers JDA, Humphrey S, Carruthers A, Jones D. Update on avoiding and treating blindness from fillers: a recent review of the world literature. Aesthetic Surgery Journal; 2019;39(6):662-674. https://doi.org/10.1093/asj/sjz053
- Ngan V. Dermal fillers and augmentation procedures. DermNet; updated 2024. https://dermnetnz.org/topics/dermal-fillers-and-augmentation-procedures. Accessed 5 November 2026.
Article history
- — First published.