How is Juvederm injected best for under the eyes?

Juvederm is best injected very carefully and conservatively when used under the eyes.  It is best not to inject too superficial and inject minimal volume.

If you inject the eyes just under the skin around the eyes, it is much more likely to be lumpy than if you inject right on top of the bone. It also hurts much more superficially. My PAs are not allowed to inject there, only me. This is because I feel that it is really good to have done the surgery, and to know the anatomy very well in this area before injecting - another reason that a Board Certified Plastic Surgeon, and a member of the American Society for Aesthetic Surgery, should be your choice to see you. Look carefully at credentials before you go in.

Juvederm and Restylane both work great to improve the appearance of hollow tear trough area. These injections are extremely technique dependent. I usually inject small amounts at different levels, some deep, some more superficial. We don't do a lot of massaging. The product has to be injected well to avoid lumpiness. If it is, no massaging is necessary. Topical numbing cream works very well in these areas, so the procedure is very well tolerated.

Juvederm is used off-label in this area.

If I am treating fine lines, then I will very gently and in small amounts inject it underneath the skin and then massage it in so it does not create lumps. If it is for tear trough areas then I will inject it deeper and massage it in as well.

I find topical creams work very well if you allow them to work (30-40 minutes). I inform my patients that if they notice lumps after the swelling goes down, then they can massage it for a day or two to flatten it out.

Juvederm is good choice for treating the tear trough area. Although this use is off label, it can be very successful. The hard part is the fact that the skin is very thin in this area. Even small lumps of Juvederm can be seen in this area.

To get the best job, I like to use a 30 gauge or smaller needle and leave very small threads of Juvederm almost directly on top of the bone. I then carefully massage the area to blend in the Juvederm.

Going slowly and doing a little at a time seems to work the best. I have seen patients where the doctor tried to put a lot of Juvederm into the tear trough and then tried to massage it into place. This generally leaves a lumpy appearance. I would not want to inject the Juvederm superficially in this area. I think the chances of seeing the Juvederm would be too great.