Under-Eye Lumps Becoming More Prominent with More Filler? A Case of Ultrasound-Guided Pinhole Removal

When a lump already exists under the eye, patients are sometimes advised to "get another injection to build up the surrounding hollow areas." As a result, what was originally a single lump turned into two—composed of different materials—that remained under the eye for a full five years.

Dynamic Compression and Shadow Effects

This condition mainly involves two core mechanisms:

1. Dynamic Compression: When smiling, the periocular ligaments pull inward, squeezing the filler originally placed in the hollow areas above the ligaments and forming bulges and lumps.
2. Shadow Contrast: When light hits from an angle, tiny surface irregularities create prominent shadows, making the under-eye issue much more visually noticeable.

Ultrasound-Guided Pinhole Extraction

Before extraction treatment, high-resolution ultrasound must be used to clearly identify the tissue layers where the two different filler materials have accumulated. Precise mapping lines are drawn, followed by stepwise removal via pinhole extraction.

Generally, about 30% to 50% can be cleared in a single session rather than achieving 100% all at once. Sometimes it takes more than one session. The video ends at three months after treatment.

For an under-eye bulge, adding more is not the solution.

Medical treatment results vary depending on individual constitution and tissue conditions.

Full case record: https://www.fillerrevision.com/en/cases/undereye-fat-graft-stimulator-nodule-removal