I have an appointment for a Juvederm touch-up in my nasio-labial folds, and i wanted the Dr. to place the leftovers around my tear trough area. I don't want the trough resolved completely, I just want the line where the eye hollow meets the cheek to be a bit softer. Many have had terrible experiences with Juvederm under the eyes, but most of the "horror stories" are when too much is injected. Is conservative use viable?
Is Juvederm Contra-indicated for Undereye Use?
Doctor Answers 11
Nonsurgical treatment for bags under the eyes
The appearance of bags, dark circles, and "tear troughs" under the eyes is a troublesome consequence of the loss of the cheek fat pads and the downward displacement of the shriveled remnants of these pads with aging and gravity. These problems commonly appear in the late thirties and become more pronounced with the passage of the decades.
Where once the lower lids were full and rounded with little evidence of crinkling and puffiness, they now become darkened, crinkled, and baggy, like the skin of a balloon deflated of all its air. Moreover, without the presence of the fat pads, the very thin and delicate skin of the lower lid region reflects the dark color of the tiny blood vessels below and of the muscles surrounding the eye giving rise to a "Panda" eyes appearance.
When we believed that all these changes resulted from skin laxity, it seemed logical to perform aggressive, invasive surgical procedures s to address these problems. However, thankfully, today, with our improved understanding of the importance of volume loss and displacement, we are able to address these issues nonsurgically--simply by restoring the volume.
Owing to its smooth consistency, I have found Juvederm, a hyaluronic acid injectable filler, to be particularly useful for tear troughs and bags. Iin experienced hands, it can be precisely, gently and artfully placed, in minute amounts, along the tear trough and then molded to achieve the desired result. Restylane has also been used successfully for this region, but I find the more homogeneous consistency of Juvederm better suited for these purposes.
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Juvederm around lower lids
Juvaderm ultra is a nice product to fill out the nasojugal groove. I have been using alot of restylane there as well They both can produce a nice result.
Juvederm is good for the tear trough. The result is dependant on the surgeon's experience and expertise. Discuss your concerns and needs with your plastic surgeon and he/she will be able to advise you
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Conservative use is fine
I see a beautiful softening of the tear trough with both Juvederm and Restylane.
The key is that the filler should only be injected medial to the mid-pupillary line (the inner half of the eye), deep enough (right on the bone), and in very small amounts. Of course, no aspirin or ibuprofen for 1 week prior to the procedure to decrease the chance of bruising.
Juvederm contra-indicated for undereye use
Easy answer is NO! But find an expert injector to inject this delicate area. I recommend a series of visits every 2 to 3 weeks to slowly build up the area. Be careful of bruising.
From MIAMI Dr. B
Juvederm for tear troughs
Both Juvederm and Restylane are used by doctors for the tear troughs. When placed underneath the muscle there is less concern of lumpiness or exagerated swelling. The placement in this area is an off-label use for both the Juvederm and Restylane. Neither are contraindicated for this area but it takes a gentle hand to deliver the correct amount.
Juvederm and Restylane work well under the eyes
Juvederm works very well in this area but must be injected very deeply, under the muscle, otherwise it can look blue in color. It must also be injected in small amounts as too much can look like a blue bulge. If you go to an expert Juvederm injector who has done many patients in this area, your risks of side effects will be much lower. Experience is very important in this area to avoid problems, but even with an experienced injector, side effects can sometimes happen.
How to avoid tear trough deformity problem
It's very common to want to use any extra juvederm/ restylane from your visit applied alsewhere including under the eyes.
As you probably have heard already this can create a whole host of problems including swelling, baggy puffiness, as well as the occasional blue hint from the filler.
Juvederm is slightly more crosslinked than restylane and as such appears to both last a little longer as well as draw in more water. That is why many doctors prefers juvederm for the correction of the nasolabial folds, but it is also the reason why you may be hearing that more patients are having problems when it is injected under the eyes.
We find that the safest approach in this regards is to either avoid the problem entirely by using your own fat, or if we are going to use fillers, to use only a very small amount to see how the patient reacts and then build accordingly. It takes a little while longer to accomplish the end goal, but we can avoid the problems that can otherwise occur.
I hope this helps and let us know if we can be of more help.
Conservative is the ONLY way to go.
I prefer Restylane to Juvederm in this area, but Juvederm is not contraindicated even though it is "off-label", meaning its use in this area has not been evaluated and approved by the FDA. Doctors do "off-label" all the time (like Botox in the crow's feet, and fillers into the cheeks). I tell my patients, I am going for a base hit (improvement), not a home run. If you are aggressive, you can see more swelling and lumping. Injections always need to be under the muscle, but inferior to the orbital rim in this delicate area.
Use Restylane for Lower Eye Lid Hollows
Many of us have stopped using Juvederm to fill under eye hollows because of excessive swelling in this delicate and unforgiving area. Many times it works fine, but in those cases where it swells too much, it can be very difficult to correct.
I would suggest that you only have Restylane placed in this area to avoid becoming one of the complication "stories" here on the web. Have the extra Juvederm injected anywhere else on your face other than the eyelid hollows. Good luck and be well.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.