Saggy Loose Lower Eyelids from Juvederm then Hyaluronidase

I had too much Juvederm injected into the wrong...

I had too much Juvederm injected into the wrong place. It led to chronic bags, poor contour and a very tired, old look.

A few years ago I had Restylane in the same place with no issues. It looked great and lasted a long time.

Hyaluronidase was recommend to dissolve the Juvederm overfill after waiting several months for the filler to go away on its own (note: it hangs around for up to several years in this area). I had 6 rounds of Hyaluronidase over several months. During that time I witnessed my skin degrade right before my eyes. This was worsened by having my lower lids stretched by too much poorly placed Juvederm for nearly 10 months. The Hyaluronidase immediately made my skin crepey, saggy, loose, with a purple pigmentation line in my tear trough. You literally wake up the next day looking like Charlie Sheen!

It appeared to dissolve my native hyaluronic acid - my plastic surgeon at the time acknowledged he could see the skin losing its elasticity and becoming really thin/wrinkled, so it was recommended I get botox, then look at doing a chemical peel, laser or start using Retin A after treatment with Hyaluronidase was complete. I agreed to the botox, but that did nothing to help with skin quality or the folds/wrinkles below the eye.

For the record, I always used Retin A on my eyelids before all this. My skin was in good condition before Hyaluronidase.

Now I am facing laser or a chemical peel to help address the state of my skin. I plan on travelling to have this sort of treatment done by a top revision eyelid surgeon. It's going to cost a fortune.

Always be careful with any fillers. Even if they can be dissolved, there can be bad results. Many of us on this forum have ended up with terrible complications from Hyaluronidase. Not only has it ruined my eyelids cosmetically, but it also dried out my eyes and left them with a constant tired feel.

It's important to realize that poor results with ANY cosmetic intervention can lead to unexpected expenses, depression, trauma and a prolonged recovery. My life has been a nightmare for the last 12 months. I used to have confidence, but I've become a hermit that hates to go out and no longer likes talking to people. I am sad that I look older than my well-preserved 40 year old sister (I just turned 30). I am sick of being told I look tired, worn out and unwell (I'm super healthy). I am scared that this damage is permanent. I was so much more attractive before. I even want to quit my career because I no longer enjoy interacting with people. It has destroyed my life as I knew it. I now have counselling to assist with the depressed feeling and anxiety caused by this situation.

Do your research. Make sure you are getting the most conservative approach with the best filler for that area. Be careful about having hyaluronidase around the eyes. If you can live with your results, then don't risk it. Dissolving it isn't as simple as it sounds!

I forgot to say please ignore the marks on my nose...

I forgot to say please ignore the marks on my nose in the "NOW" pics. It was from pure tea tree oil on a zit that burnt my skin!

Added a whole bunch of photos to show the...

Added a whole bunch of photos to show the progressive dissolving process.

Hopefully forum visitors will see my pics and be more cautious about their choices.

These pictures help demonstrate the much talked about potential side effects of Hyaluronidase.

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how it looks now ? can you tell us Raleigh4718 please ? did you fill again or let it so and how it looks now ? i`ve have the same experience .... best wishes nelly
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I don't think Raleigh has posted on this thread for a long time.
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Raleigh: I know this doesn't help diminish the stress and depression or take away the physical issues you still see but I want to let you know, you are beautiful and your skin will tone and texture will return for the better. mine is not what it was PRIOR to filler and treatments but it is 99% better than how it I had dark black blue streaks running from my tear-trough to my lower orbital bone after the first few injections of Hya and then I had Vitrase put in which took all that away, including the residual indentations and lumps from left over filler. It took three years for me to get my face back to where I could look in the mirror and NOT cuss that originals doctors name out and then some.... That doc had put the filler so close to the surface of my skin under my eye area that the surface looked like the texture of raw chicken skin in addition to the obvious unnatural fullness that was so even and lumpy... In flouresent lighting, I looked ghastly- Stark-white around the eyes and the lumps of filler were even more pronounced in that lighting. Try Vitrase... it is of different compounds and very effective. I had two rounds of Hya with out much success and a lot of problems associated with it. I then had four rounds of Vitrase put in at a depth of Single-cell- about the depth a TB test would be done and it is finally gone- smooth, no tyndall and no swelling in the mornings anymore. No bags and my skin is no longer thinned like crepe paper.
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cut the extra skin out
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It doesn't really work like that around the eye as you also have to take into consideration fat and fluid. It would look very odd and unnatural just to trim some skin.
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I have the same loose skin, and fold when I talk or smile from dissolving with hyaluronidase. I consider it permanent. Did yours ever come good?
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As far as I know, Raleigh, the person who started this thread hasn't commented for a long time. Loose skin of the eyelids as far as I know, needs to be removed surgically, unless filler is an option. If the doctor who left you with loose skin did not mention that this could result, I would find another (better) doctor for the solution. Fortunately, my dissolver brought me back to what I would be if I never had the filler, with the exception of some slight yellowing, possibly due to my Gilbert's Disease, which had already yellowed a small area on an upper eyelid. Defiinitely use an oculoplastic, because it's the most specific subspecialty for your problems on your area of the body. Unless you know of a very good cosmetic dermatologist with lots of great results treating bad results with eye area fillers, go to an oculoplastic surgeon who is highly recommended, has done many successful corrections to bad hyaluronidase, etc.
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Thank you for your excellent advice. I have an appointment with an ocular plastic surgeon in a few months. My lower eyelids are really destroyed.
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KP72, and others: Best to get at least 3 consultations before choosing the surgeon. It's recommended at the consultation you ask many questions, including how many total of the recommended procedure the doctor has done successfully. The total number should be at least 100. Another question is how often the doctor does it. The answer should be at least 2 times weekly on average. Another question is the last time the doctor performed it and the answer should be within the last two weeks (unless of course the doctor has been away for some reason.) If you can meet a patient in person who already had the procedure by the doctor, this is very good also but hard to do, especially nowadays. If there were any scars from the procedure, ask the patient if there were any. Look for any signs of scarring whether normal or not. I was able to do this with my first facial procedure (under chin lipo). Another thing sometimes available is to communicate with a former patient without actually seeing the person. Of course it's good to see before and after photos of patients. One local doctor shows photos of OTHER DOCTOR's patients! This is a huge red flag. RUN from any red flags! You need a full arsenal before having surgery. Another thing to do is go to various beauticians at various shops and ask around. Beware of hearing the same local doctors name by people in that local area. When the same name pops up locally it may simply be because that doctor is the only one known. On the other hand if the same name pops up far and wide, that is probably a renowned doctor, at least in the area. Good luck and keep us posted.
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Thanks for your excellent advice. Much appreciated! I am in Australia so my choices are a bit limited. I am certainly asking around and I am more than willing to travel. The same name keeps coming up over and over - Dinesh Selva. He only does eyes. His credentials are impressive but I know that doesn't translate into actual results. I will be sure to ask a million questions and I'm going to write them out first (including all of your recommendations) in case I get nervous at the appointment and forget! I am going to make an appointment in a few months as I want everything to settle down first. Too many disasters in a row! My main worry is how the filler that I had after the hyaluronidase disaster will affect the result of a blepharoplasty. My gut instinct is not to consent to any hyaluronidase being used in the surgery. It is routinely used in surgery to disperse anaesthetic but for people who have used filler it will take that out also. I know that filler lasts many, many years in the tear troughs. Mine was five years old when it was dissolved and the results were devastating. Maybe filler never really goes away? I also absolutely know hyaluronidase ruins skin and tissue, especially around the eyes. I will be sure to ask about the impact of a past history of filler and hyaluronidase at the consult.
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Hi KP72 I also had a very bad experience juvederm. Months after the injection in my left tear trough, my cheek swelled incredibly. The doctor who injected was inept and had no clue. After being treated as a biofilm infection. ( it wasnt) I finally realized it was just that the Juvéderm was injected too close to my tear trough, and too close to the surface. I went to a very reputable plastic surgeon who treated me with multiple Hylenex Hyaluronidase treatments and they were very successful. There are different varieties of hyaluronidase, and it totally matters who does the injections by the way. Thanks to him and hyaluronic days I'm finally back to normal. So your experience may have been bad with that but some of us have a good experience I just wanted to let people know. Pick the right plastic surgeon and I would recommend Highland exit over by vitrase. Best of luck to you with your situation.
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Hylenex mot highland exit!
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Yes. I can see that some people are very relieved after their HA filler disasters have been dissolved. I can also see that not everyone experiences the indentation, discolouration, loose and crepey skin, puffiness etc, but a lot of people do. The risk for each person considering dissolving filler with hyaluronidase is that nobody knows in advance what will happen. Unfortunately there does not appear to be a consensus as to preferable brands or amounts to use or dilution ratios for hyaluronidase so it's so bloody hard to work out why the outcomes are so different. We can't compare apples with apples. On top of that is different reactions for different people and some people even have allergies. And the outcome may also be related to how long the filler has been there and the type of filler used. So many variables! My main worry for people considering dissolving filler is that the doctors don't know what is going to happen and if you are the victim of a bad outcome like me, the experience can be life altering. My result from hyaluronidase was so bad that I had to stay home from work for a week until a refill could be attempted. It was not an initial reaction to the enzyme either. It was the final outcome except for some transient bruising down my cheek which has since faded. The other bad effects as listed above have only been partially camouflaged by the replacement filler. My husband and my mother could hardly believe their eyes and they both saw me before and immediately after the injections. My eyes have looked terrible every day since that filler was dissolved and I am devastated by it. I am glad your experience with hyaluronidase was successful because I would not wish my situation on anyone. And I genuinely do not know if the chance of a good result is worth the risk of a result like mine.
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I will enquire as to whether my poor result with hyaluronidase was with Highland exit (ha!) aka Hylenex or Vitase.
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so my question is did your doctor do the hylase directly in your eye-lids or superficial ? and did you have the first time hylauron acid filler there or the first time before you do hylase or anywhere else?
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also how much do your doctor do the hylase treatment ? i have find a doctor, who has also hylase on her own in the eye-lid .... !!! she is a plastic sugery, who do just filler-injection every day ... !!! she said to me, the filler in the eye-lid never dissolve alone because we don't have enough enzyme there ... !!! so if you go older you skin change and the eye-lid loose skin so the filler also .... !!! the only way is to dissolve the filler with hylase !!
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In July 2009, Juvederm Ultra was put along my orbital bone to correct tear trough deformity and lower eyelid bags. In July 2014, a very small amount of hyalase was injected into my lower eyelid skin quite superficially where the filler had been placed. It dissolved all the old Juvederm very quickly. Looked horrible!!!! Indentation, black discolouration, loose skin, puffiness and extra wrinkles. One week after the dissolving I had some more HA filler called Volbella put back in. It did not look good. Last week I had a bit of Juvederm Ultra put in my tear troughs. It looks a bit better but not the same as before the dissolving disaster. I still look crap.
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The Juvederm Ultra from 2009 in my lower eyelids was five years old when it was dissolved. It had not dissolved in its own.
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I totally understand because the PS who treated me (not the injector!) was as confused about what happened. I'm actually glad I got treated for biofilm even though it wasn't and further surprised about the diffences in hyaluronidase brands. Vitrase was tried on me first when I initially went to the injector to see wtf was up (that was the last time I darkened his door!) The PS who used Hylenex had very specific reasons and I wish I could remember them. I only post this to give hope to others that the correct PS snd treatment can restore your face and sanity. But yes foes it require research , patience and the right doctor. I hope your surgery gives you back your eyes! Xo
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Oh thank you so much. I hope so too and I am prepared to be patient although it's very difficult. I just want it to be over but I know I'll only make it worse by rushing into a blepharoplasty. Not worth the risk. Must let it all settle down first. Hyalenex is derived from human products so apparently it has less chance of an allergic reaction. But I note that after other brands had been attempted, only Vitrase helped the RS member "Puffy and Pissed" and she had it injected directly into her lower lids. Her result was magic and mine was hideous. It's a crap shoot. Where did you have the Hyalenex? In your cheek?
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In a case where you had a bad result, it's also important to ask how many revisions/repairs on your current issue (bad filler and bad hyaluronidase in tear trough). If you and doc agree on a lower bleph as the procedure, ask also how many he did as revision procedures after bad filler followed by bad hyaluronidase. This may not be able to be treated as any other lower bleph because you don't have just naturally loose skin or garden-variety eyebags. Make sure you get a good explanation that sounds convincing that the doctor has already treated problems almost identical to yours. Also the lower bleph can be done externally, which is when there is loose skin or internally, through the reddish membrane, only for fat removal or replacement. It's possible external bleph would be needed to lift up muscles and other structures. I have heard they never do a lower bleph just to remove fat. The external version has a little more risk too -- skin pulling, draping improperly, not being able to close eyes, etc. My current doctor was referred by my eye doctor as well as the name popping up at cosmetology offices and on forums. I've had body electrolysis to mac-s-lift and the only procedure that went wrong was my under eye filler but I did not screen my doctor for that particular procedure like I did all other procedures. Also many people did not like that doctor's personality. This too turned out to be a red flag that I paid no attention to. Again, the entire arsenal -- high success rate with your procedure, high success rate dealing with your type of history of procedures in that area of face/body, seeing b and a photos or meeting a patient in person with your history and same procedure, recommendation by another doctor, especially a specialist, recommended by local people as well as people a little beyond the local area. (The only local doctor in your area may not be good.), recommended by those on forums such as this one. If you hear about one procedure that someone was highly dissatisified with, you may or may not want to screen out that doctor. The more renowned the doctor, the more likely that doctor will have one negative review. Take into consideration that a doctor who has done 1,000+ of any procedure could have one negative review on a procedure similar to yours, which may be acceptable. Again, depends on the severity of the review. For this type of problem with bad injectables in the lower eyelid area an oculo or cosmetic derm is the safest. Last but not least, the personality of the doctor. If many people complain about the personality, probably best to screen out that doctor. One other consideration is anesthesia. This is at the discretion of the doctor and to some extent, the patient. I would avoid general anesthesia, but some patients and doctors insist on it to avoid the possibility of waking up with IV sedation or local. Waking up is usually not a problem, as a good anesthetist looks for signs of consciousness. I will be having mine with local and possibly a touch of IV sedation, as I'd like to try IV. All of my procedures were done under local, with surgeries also involving a dose of oral sedation. I think if you follow all I've mentioned in this post, you have a renowned doctor or one who is up and coming or should be renowned. :)
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Correction, they never do an external bleph nowadays just to remove fat.
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HI KP72 - sorry for the delayed response, I've been super busy! I had the Hylenex injected all around my cheek area because we literally couldn't figure out what was happening and where. I mean, we had the chart the injecting doctor made, but when we put the hyaluronidase in that specific area, not much happened. That areas was the top of my cheek right below the lower eyelid (which is why it had/has been swollen.) I had Juvederm Ultra Plus so I think it's true that in the tear trough and lower eyelid area it can attract fluids in the body. After the initial injections there, we experimented by going where the most pronounced swelling was...by my nose, lower in the cheek. It was mysterious. And as skilled and talented as the treating PS is, who admitted it was a crap shoot for him, too! He'd never seen this reaction before. Again, all was normal from Nov 2013 to March 2014 - so it was a delayed reaction for me. The swelling started 4 months after the injection. So my face became an experiment. We rolled the dice each time. However, my PS had only good things to say about his experience with Hylenex - that during some of his training, the doctors would inject each other with HA and then take it down with Hyenex successfully, so I felt confident in it's use on me. The last injection, we decided to go for it with a large dose. I had had a total of 5 injections that were conservative prior to that. I just told him, it seems to be working little by little, lets just do a bigger dose because I was ready to get that crap out! It did knock out the majority, however, I still have some left. That last dose was several months ago - and YES there is noticeable, temporary disfigurement as the Hylenex works out the majority of the HA and then whatever is left over of the HA has to naturally go away. I've seen it change a lot over the last few months. Only now do I see my prior look returning (thank God!) It's a test of patience for sure. But I am glad I went this route and didn't wait years and years. However, I realize it's going to be different for everyone. Right now, the swelling in my cheek has reduced by 85% from the height of the experience. I still have occasional swelling in my under eyelid, but it's so much better. I imagine this will be the case for a bit longer, but it is so much better than it was in May of this year! Good luck with everything! Biggyc
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Thanks very much for taking the time to give me your excellent advice. I appreciate it. You have identified my precise worry - that nobody will have the skill or experience to address a situation caused by bad hyaluronidase then a bad HA filler refill. I am the most anxious that they will want to dissolve it again, which I do not want. I simply cannot live with the puffy Nike swooshes under my eyes so I must do something. I look horrible. Even the fake glasses do not cover it up. I have looked horrible for three months now and it is breaking my heart.
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I am really glad that you are looking and feeling better. And thanks for taking the time to answer my question. I really look horrible around the eyes and nothing at all seems to help. I try not to care but it is devastating me. My confidence and self esteem are shattered.
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