Tear trough filler, a common treatment for under-eye hollowing, uses injectable hyaluronic acid (HA) to restore lost volume and reduce the appearance of dark circles. Swelling is an expected and temporary outcome of this procedure because the injection process causes minor trauma to the delicate under-eye tissues. Additionally, hyaluronic acid is a hydrophilic molecule, meaning it naturally attracts and holds water, which contributes to temporary post-procedure puffiness as the filler integrates into the surrounding tissue.
The Standard Swelling Timeline
The initial swelling begins almost immediately after the injection, a direct result of the physical trauma from the needle or cannula disrupting the tissue beneath the skin. This immediate puffiness is often mild and can include slight redness or tenderness at the treatment sites.
Swelling typically reaches its peak intensity within the first 24 to 72 hours following the procedure. During this period, the under-eye area may appear noticeably more puffy than the desired final result. The peak is a combination of the body’s inflammatory response and the HA filler beginning to draw in surrounding water.
After the third day, the inflammatory response begins to subside, initiating a gradual reduction in visible swelling that continues over the next week. By day four through seven, most patients see a significant improvement, and the treated area starts to look smoother and more natural. Minor bruising, if present, also begins to fade significantly during this time.
The filler requires time to fully settle and the surrounding tissue to completely normalize. Most residual swelling is gone by the two-week mark, at which point the results are largely visible. However, trace amounts of fluid retention can persist for up to four weeks as the hydrophilic HA fully stabilizes within the tear trough area.
Factors That Influence Swelling Duration
Several variables can influence how quickly an individual’s swelling resolves. The specific type and viscosity of the hyaluronic acid filler used play a role, as fillers with a lower G-prime (elasticity) are often preferred for the tear trough because they tend to attract less water, potentially minimizing fluid retention. Conversely, a filler placed too superficially, or in too great a volume, can exacerbate swelling and prolong its duration due to compression of the delicate lymphatic drainage system beneath the eyes.
The injection technique influences the degree of tissue trauma; a blunt-tipped cannula is generally associated with less bruising and swelling compared to a sharp needle. A patient’s individual biological factors, such as their metabolism, skin thickness, and propensity for inflammation, are significant determinants of recovery speed. Pre-procedure preparation, including avoiding blood-thinning agents like aspirin or certain supplements, can reduce initial bruising and, subsequently, the swelling that accompanies it.
Immediate Post-Procedure Care for Swelling Reduction
Applying a cold compress to the treated area is one of the most effective methods for reducing inflammation and swelling in the first 48 hours. The cold temperature constricts local blood vessels, which helps to minimize the influx of fluid to the injection site. Apply the compress for short intervals, typically 10 to 15 minutes every few hours.
Keeping the head elevated, particularly while sleeping, aids in fluid drainage and prevents excessive pooling overnight. Patients should sleep on their back with an extra pillow for the first two nights to position the head above the level of the heart. For the first two days post-procedure, avoid strenuous exercise or activities that substantially increase heart rate and blood flow to the face.
Alcohol acts as a vasodilator and a diuretic, which can worsen both swelling and bruising, so it should be avoided for at least 24 to 48 hours. Similarly, limiting excessive sodium intake helps to prevent the body from retaining additional water, which the hydrophilic filler is already attracting.
Identifying Normal Swelling Versus Complications
While some degree of swelling and bruising is an expected part of the healing process, certain signs may indicate a rare complication. Normal swelling should feel soft and gradually decrease after the initial 72-hour peak. If the swelling worsens significantly after the third day, persists beyond three weeks, or is accompanied by severe, throbbing pain, a medical professional should be consulted.
Discoloration of the skin beyond a typical bruise is a serious warning sign, especially if the skin turns mottled, pale, or dusky blue, which may signal a vascular occlusion. It is frequently accompanied by sudden, severe pain that does not respond to over-the-counter pain relievers. Other concerning symptoms include signs of infection, such as fever, warmth, or increasing redness at the injection site, or any sudden visual changes.
Delayed swelling that appears weeks or months after the procedure is not part of the normal healing process and can be linked to an inflammatory response or localized infection. The body can trigger an immune reaction to the filler material, which may present as uneven puffiness or small lumps. Any symptom that deviates sharply from the expected timeline of mild, resolving swelling warrants a prompt follow-up with the injector.