Injection into the lower lid area is followed by pinpoint bruising in most cases, which is easily covered but can take about ten days to clear. Slight puffiness on waking, tenderness, and small palpable deposits are common in the first weeks. Uneven placement between the sides may need refining at review. Because the material is absorbed, the change lasts months rather than years. Infection at the puncture points is uncommon and treated promptly.
Hyaluronic acid in the tear trough attracts water, so swelling here settles more slowly than elsewhere and can persist for two to four weeks or longer. Because the skin is thin, gel placed too superficially may show as a bluish shadow, the Tyndall effect, and lumps or ridges can be felt. Bruising is frequent. Excess volume, delayed puffiness, and asymmetry are corrected by dissolving with hyaluronidase. Vascular events around the eye are rare but serious.