Indented Areas from Hyaluronidase Injections

I had hyaluroniase injected to lessen the raised worm-like lines from overfilling of Juvederm in my eye/cheek groove. I went home with ice pack and pressed repeatedly. I ended up with the areas looking wasted away and indented. It seems that the areas will have to be injected with Juvederm again to make it look normal. Will this tissue ever grow back? Will I have to fill these areas forever every 6 months?

Doctor Answers (6)

Hyaluronidase is not a tissue dissolver

+2

Hyaluronidase should not have caused those "dents" that you see. More likely all the Juvederm was not dissolved and thus you have pockets with and without Juvederm. I would give it some time and then consider getting Juvederm back to fill the pockets. Remember the injection of the hyaluronidase is not an exact science, you have to add small amounts and you tend to have little control on the area of filler it dissolves. You may need a touch up. 


Washington DC Oculoplastic Surgeon
5.0 out of 5 stars 6 reviews

Continue your care with a board-certified specialist

+2

It is very difficult to answer your question without the opportunity of a physical examination or even the ability to review a recent photograph. It sounds like you have problems following Juvederm injections into the facial area involving the lower eyelid-cheek junction, also known as the tear trough area. Treatment of facial contour irregularities are both technically and aesthetically demanding, especially in the tear troughs.

Juvederm is a dermal filler which is made of non-animal stabilized hyaluronic acid. Juvederm is not permanent, only lasting up to nine months or more. The effects of Juvederm may be reversed by an injection of hyaluronidase, which evidently was performed to correct the ‘overfill’. Now, it seems that you may need additional dermal filler into the tear troughs or lower eyelid-cheek junction. My best advice is to continue your care with a specialist that has extensive experience in soft tissue fillers and is boarded either in plastic surgeon, dermatology, or facial plastic surgery.

Stephen A. Goldstein, MD
Englewood Plastic Surgeon

Bring your concern to the attention of your injector

+1

Perhaps the injected areas appear "indented" because of the surrounding, residual Juvederm material raising the surrounding skin. I have seen a few cases of hyaluronidase correction to the lower eyelids and have not seen any noticeable, permanent loss of tissue volume as a result of hyaluronidase injections.

Although it is true that hyaluronic acid is a natural component of our connective tissue, I think it is still likely that once your Juvederm wears off, your appearance will return to how it was prior to your Juvederm injections. Incidentally, there are a lot of good cosmetic dermatologists in Miami.

Good luck.

Bryan K. Chen, MD
San Diego Dermatologist
5.0 out of 5 stars 4 reviews

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No need to worry

+1

Hyaluronidase will not dissolve your natural tissue, only the hyaluronic acid filler. So there should be no permanent change. What might have happened is that some of the filler is still there and you are seeing the difference between the areas that are filled and your natural state. In other words the valleys are normal, there are just hills around it.

I would speak to your treating doctor to see what s/he thinks. Your options are either to get a little more filler in the depressed areas or more Hyaluronidase in the raised areas. If you do nothing, it will return to normal over the next 6 months to a year.

Hope this is helpful.

Marc Cohen, MD
Philadelphia Oculoplastic Surgeon
5.0 out of 5 stars 8 reviews

Try Restylane with a very experienced doctor

+1

To lynnrichards,

Hi! Using fillers under the eyes is VERY tricky, and as you know unfortunately, problems in this area are not uncommon. I use Restylane under the eyes because it is the most forgiving ( I use Juvederm in the cheeks, nasolabial folds, and jawline.).

Restylane under the eyes should be injected DEEPLY and in very small quantities. It lasts a long time in this location ( over 9 months ).

To answer your question, you probably have had a little tissue atrophy and will continue to need fillers.

This groove can also be corrected with surgery, by covering the bone rim with fat. And this approach is permanent.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
5.0 out of 5 stars 9 reviews

A good option may be fat grafting

+1

Lynn,

A good option to repeated filler injections is fat grafting. In this procedure, we use a micro-liposuction technique to remove some fat cells from your thigh or abdomen. We then process the cells and then inject them into the defect just like we inject a filler. Since the cells are your own living tissue, there is a good change that they will continue to life after the transplant and give you longer or even permanent results. Good luck.

David Shafer, MD
New York Plastic Surgeon
5.0 out of 5 stars 57 reviews

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.