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Puffy Eyes After Juvederm Injections in Under Eye Hollows

I had Juvederm injected below my eyes to fill in hollows, and now I have pillows instead. It looks horrible. My doctor said that only surgery would fix this and he stated I should have had eyelid surgery all along. He suggested I initially try the injection because I cannot afford surgery right now.

Doctor Answers 32

Juvederm injection for hollow eyes can make puffy eyes and hollow eyes worse

I agree that the skill of the doctor who injects Juvederm usually is most important for a good outcome.

However, I do not inject Juvederm, Radiesse, Restylane, Perlane Evolence, Sculptra or any filler to correct eye hollows for several reasons;

  • Eyelid skin is so thin and delicate that fillers often show through as grey lumps
  • True hollow eyes require composite fat grafting for adequate correction-filler volume is not enough
  • Fillers are hard unlike fat and are unnatural consistency for correction of hollow eyes
  • The action of the eyelid muscle pushes the filler downward plumping the upper cheek and making the hollow eye look worse
  • Discoloration from bruising can be permanent as hemosiderin pigment is left behind
  • It is dangerous to "blindly" inject with a needle around the eye-blindness has occurred with filler injection around the eye

In time with massage the filler will dissolve. Don't use Hyaluroinidase around the eye.

Swelling versus too much filler

When did you have the injections? You may be swollen for several days after the injections, and bruising may also cause some swelling. If there was too much filler injected causing the "pillows" the best treatment is hyaluronidase. Hyaluronidase is injected into an area with too much filler and it dissolves the filler away completely.

Also, the fat pad that is under the eye can itself puff out with time and look like a little pillow. If you then have filler placed in the groove below the eye (and below that fat pad) it may look like the pillow is larger because the groove is now gone. If the fat pad is your problem than only surgery will fix it. But if the pillow is from the filler than you need hyaluronidase.

Jordana S. Gilman, MD
Atlanta Dermatologic Surgeon
5.0 out of 5 stars 2 reviews

Under-eye filler can be puffy for a few days

Juvederm is a hyaluronic acid-based filler that is quite soft and well-tolerated in many clinical situations. One consideration in the setting of puffiness after injection is that this type of filler is hydrophillic, meaning it attracts water. For a few days, this can be seen as swelling or puffiness, which generally resolves. Some patients see some benefit by using warm compresses to help the fluid subside. If your swelling is within the first few days after having a filler injection, this may improve spontaneously.

Hyaluronidase is an injectable substance that can dissolve filler in the case that there are lumps or bumps caused by the filler itself, not filler-related swelling. Rarely is a hyaluronidase injection necessary when fillers are placed correctly.

Fillers under the eyes can supplant surgical options in many cases. We now understand that the appearance of under eye bags can be areas of fat that are accentuated by hollowing below. By filling the grooves under the eyelids, surgery may not be required in some cases. In fact, in some cases, removing fat can create an aged or even more hollow appearance to the eyelids! Current techniques may involve fillers alone, a combination of surgery and fillers, or using native fat to restore volume.

Brett S. Kotlus, MD, MS
New York Oculoplastic Surgeon
5.0 out of 5 stars 26 reviews

Tear Trough Treatments

Performing "tear trough" treatments to the hollow areas under the eyes requires meticulous technique and can be a very satisfying treatment when done correctly. What you are describing sounds as if the injector placed the product above the muscle rather than below it. This will usually result in the look that you are describing. When done correctly, tear trough treatments should provide improvement rather than rendering a worse outcome.

When we determine someone is not a good candidate (too much skin laxity, profound fat pads, too thin of skin) we discourage this procedure. However, the majority of our patients benefit from this procedure and are pleased that this may be a good option to surgical intervention for many.

As the other panel members suggested, if the "puffiness" is clearly not post-treatment swelling, hyaluronidase will be able to dissolve the product.

On a sidenote, we do not use Juvederm for these treatments and prefer Restylane.

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
5.0 out of 5 stars 6 reviews

Good news: Excess Juvederm can be removed

It sounds like you now have 2 problems: your original hollows and a new deformity caused either by too much Juvederm or by incorrectly injected Juvederm.

I think you need to deal with the Juvederm first. There is a medication called Hyaluronidase injections and these can dissolve the Juvederm. This excess Juvederm cannot be removed with surgery.

Once you are back to your original hollows, you can save your money for corrective surgery. I should also tell you that surgery to correct lower lid hollows is difficult and has inconsistent results. So get more than one opinion and ask to see lots of before and after pictures.

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

Juvederm swelling under the eyes

One of 3  things will cause this effect: 1. The product was injected in the wrong plane or level of the skin  2. Juvederm can cause this type of swelling under the eyes even when placed deeper in the correct plane of the tissue by experienced injectors or 3 too much volume was used for the correction.  Either way it is amazingly simple to resolve with hyaluronidase injection ("the antidote" as some call it).  If your doctor doesnt offer it, go get it from someone who does. Then decide about another filler in the area or surgery. Dont fret, there is an easy solution to your problem.

Shawn Allen, MD
Boulder Dermatologist
5.0 out of 5 stars 1 review

Juviderm for Eyelid Hollows

Hi Anon,

Sorry for your bad experience and puffy eyelids after Juviderm. What we usually say is that it's not the "filler", it's the person putting the filler in. You may have had too much lower lid fullness from fat for the Juviderm to be effective, but in that case it should not be used. The use of fillers and even Botox are medical procedures that should be performed by cosmetically trained board certified physicians in a cosmetic field (plastic surgery, facial plastic surgery, ENT, dermatology, oculoplastic surgery).

At this point if massage and tincture of time do not improve your puffiness, you may consider hyaluronidase injections to diminish the Juviderm. Good luck and be well.

Dr. P

Michael A. Persky, MD
Encino Facial Plastic Surgeon
5.0 out of 5 stars 28 reviews

Juvederm swelling tear trough

If your swelling has developed after juvederm injections, a simpler solution would require injection of hyaluronidase which can be used to effectively dissolve such filler. Juvederm injections are known to be associated with occasional swelling which might explain why many experienced injectors would consider other brands of fillers (including restylane) for that specific location of the face. Surgical options should only be considered if there is no improvement with hyaluronidase. 

Andrei Metelitsa, MD, FRCPC
Calgary Dermatologic Surgeon
5.0 out of 5 stars 3 reviews

Filler around the eyes

This is an issue I see quite often in consultation as I practice in an area that is very much like the "Wild West" - consumers do not do their research and choose wisely before choosing their injector. They tend to choose more based on price and convenience, with dentists, cardiologists, OB/Gyn, general surgeons, etc. doing quite a few injections.

First things first, almost every key thought leader in the field agrees that Juvederm products should not be injected around the eyes. These products are fantastic, but they attract too much water for that particular location. There is no gentle way to put it, this is the sort of thing you should learn on the first day of your filler education, but unfortunately I see it all the time.

When this mistake is made, Hyaluronidase is an excellent option to dissolve the filler in this location, not surgery, and anybody who tells you that it is not safely injected around the eyes just doesn't have the experience with it. In fact, it is commonly used as part of local anesthetic mixture for eyelid surgery.

Again, I would be cautious of anybody who tells you that filler around the eye is a bad idea. Physicians who are skilled in rejuvenation of the periocular area (around the eyes) will have lots of good photographs and discussion of both their surgical and nonsurgical options. In my hands, I am often able to achieve near surgical results with filler, with the caveat being that filler does not last forever - surgery has a more permanent effect.

To ensure you are receiving the highest level of care, seek out a dermatologic surgeon, oculoplastic surgeon, facial plastic surgeon or plastic surgeon who is board certified and fellowship trained in one of these "core four" cosmetic specialties.

Cameron Chesnut, MD, FAAD, FACMS, FASDS
Spokane Dermatologic Surgeon
5.0 out of 5 stars 12 reviews

Formulate a Plan With Your Surgeon:Surgey May Be A Better Option

It’s not unusual for patients with facial aging to note changes in the periorbital region. When these changes are severe, patients often need a blepharoplasty. When these changes are mild, temporizing maneuvers with injectable fillers are often helpful. Under these circumstances, most patients are treated with hyaluronic acid fillers such as Juvederm, Perlane and Restylane.
When dermal fillers are used to correct this problem, success is related to proper patient selection. Unfortunately, it appears that a blepharoplasty might have been a better choice in your case. In this situation hyaluronic acid fillers such as Juvederm can be reversed with hyaluronidase. Despite this maneuver you’ll still have your original anatomic deformity which will ultimately require a blepharoplasty.
It’s important to discuss your situation with your surgeon. Your surgeon should be able to formulate a plan that’s appropriate for your problem.

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.