Tear Troughs - A very unforgiving area

All of the panel members offered a broad range of valuable feedback. However, in reading the original posting, it would appear that possibly the product was not placed under the muscle in the second treatment. Although hyaluronidase was used to dissolve the product, unless it was placed exactly where the filler was placed, it will not offer much benefit. This may account for why you are describing being able to still feel the filler product but have "bags" of fluid above it. You may also be creating a vicious cycle by self-treating in an effort to find a resolution. Because this is a delicate area, you may be aggravating the condition.

I would agree that you should be evaluated by a physician that is familiar with injectable fillers for tear trough procedures. The last panel member mentioned that this does not mean you should go to a nurse at the local medspa. While this may have been well-intentioned advice, it certainly does a disservice to registered nurses and assumes also that it was a non-physician that performed the treatments that resulted in a negative outcome.

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Hi Tried Aussie,

The puffiness and swelling will resolve with time.  The edema is not permanent and the hyaluronidase has not done irreparable damage.  I have treated a few patients with similar scenarios, and eventually their lower lids returned to normal.  You do need to be patient.  The most difficult thing to do is nothing.  It may take weeks to months.

Do follow the good doctor's advice here on RealSelf.com and see a board certified opthalmoplastic surgeon, facial plastic surgeon, or plastic surgeon who has experience with injectable fillers in the lower eyelids.

Once again, in the future, I would recommend using Restylane in the delicate lower eye lid area as sometimes Juviderm is a little too hydrophilic (attracts too much water from the skin) and swells too much.

I hope that your eyelids return to normal very soon.

Dr. P

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Dear Tried

I honestly don't think you can know whether you are coming or going.  You have done so many things in such a short period of time.  It is quite possible for example that you are in fact not allergic to the hyaluronidase.  It sounds a bit like you are treating yourself.  It is my opinion that if you are in fact allergic to hyaluronidase you should not be getting more filler to the lower eyelids which based on your description in your review you did.  

There is a simple way to know if your are allergic to hyaluronidase, have a cosmetic surgeon or cosmetic dermatologist who knows what they are doing inject hyaluronidase in a small dose under the skin on the arm.  If you react with an allergic response then it will be clear that you are allergic.  If you don't react then you are not allergic.  If it is felt that you still really need the hyaluronidase, an allergist will need to desensitize you to egg products.

From your description of your response to the hyaluronidase, it is not at all clear that your reaction was an allergic one.  Bruising, and boggy swelling are to be expected.  Also the product is not a magic wand that removes all the hyaluronic acid product.  Often product gets distributed in many different layers in the lower eyelid and top of the cheek.  Removing product like this is a process that often takes several visits.  You have also complicated the matter by letting someone put more product in an already not so good situation.

My advice is to find a real clinician who can help you.  Find the person in your area (or travel if necessary) who knows what they are doing, not the nurse at the local medispa. Get skin tested to determine if you are or are not allergic to the enzyme. And stop treating yourself. The steroid creams can destroy the delicate lower eyelid skin.

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