Mitesh Kapadia, MD, PhD

Contrary to what most people think, fillers can often many years, especially when they are causing a problem. Dissolving the filler with hyaluronidase should help get rid of it much more quickly and is a very safe procedure in trained hands.

Based on this photo, it looks like you would be an excellent candidate for lower eyelid surgery. This can be discussed further during an in person consultation.

Hard lumps after fillers are not normal and should be dissolved. These are likely your body mounting an immune response to the fillers called a granuloma. They are best treated with hyaluronidase injections to dissolve the filler. It often takes multiple rounds of dissolving to get rid of these.

Sculptra and Voluma are very different fillers from an immune standpoint and unlikely to have cross reactivity. That being said, if there were a problem, Voluma can be notoriously difficult to dissolve. If patients have concerns about immune reactions, I usually recommend using Restylane Lyft in the cheeks which also works well in this area and is much easier to dissolve if there are any issues.

Its not recommended to get fillers or Botox while you are pregnant or nursing, as tiny amounts of product may enter the bloodstream during injection and reach the fetus or baby. There is no known risk if you get pregnant after having these products.

Fillers can not actually lift tissue, but can produce the appearance of being lifted. In my opinion fillers are the best option for you. I would recommend an in person evaluation to determine what treatments will help you achieve your goals.

It looks like there is some excess skin on the outer corners of your upper eyelids. Conservative skin removal will give your eyes a brighter look and provide a platform to wear eye makeup.

Under eye wrinkles are very difficult to treat and there is no way to get rid of them completely. I would recommend resurfacing the area with a CO2 laser to help tighten the skin.

Its definitely possible to place Botox just in the procerus and not treat the forehead muscles. Usually this works fine. Once in a while, placing Botox in one muscle can cause some changes in the use of other muscles. This can always be corrected with a minor touch-up if this happens.

Your main issue is extra puffiness under your eyes. This is best treated with surgery to remove the extra fat. Fillers may help to camoflage the extra fat, if you want a milder improvement but surgery would be a much better option. You also have a mild malar bag which can sometimes worsen after filler injections.