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I recently saw a patient that her tear troughs treated with Juvederm nearly two years ago. Right side great. Left side bad. Even now it looks puffy. And the patient says it had always been that way. I asked her if they injected hyaluronidase and she felt they had. The filler should have cleared by this point and I'm not sure what to tell the patient, structural damage? scar tissue? I declined to treat that area but told her I would research it for her. Any clues?