Indents either side of nose after fillers. What is causing this and how can I get rid of it? (Photo)

Question

I have had tear trough fillers and Botox (over a long period of time) and I have noticed indents appear either side of my nose, below the troughs. I’m incredibly conscious of these and they show up more when I smile. Because of this, I had my tear troughs dissolved and reapplied but the indents still remained. I never used to have these and can only assume it’s because of fillers. What is causing this and how can I get rid of it?

David M. Kowalczyk, MD, MBA, FACS · Answer

Good Morning! Thanks for the photos and questions. Some of what's present could be filler being placed and dissolved. Hyaluronidase is powerful and there are reports of the enzyme causing volume loss when injected in higher amounts. Fillers like Restalyne Contour work well in the medial cheek. Another filler would be Belotero. Longer-lasting options would be fat transfer to the area. Fat can be harvested from the belly button area and placed within the cheeks. The results are often very natural and last 5-10 years on average. I would seek consultation with a surgeon who also has a Med Spa to see what may be best as skin treatment may be needed to supplement the result. Hope this helps!

Nelson Lee Novick, MD · Answer

At least from the photos, it appears that the indents seen in the photos are in fact "valleys" below what has oome to be known as under-eye puffy pillows, which are in fact the result of lymphatic obstruction (i.e. lymphedema). These puffy pillows usually arise following the use of an inappropriate HA filler in the tear trough regions and/or is injected too superficially within the delicate under eye tissues. Puffy pilllows are notoriously difficult to treat. I have had success, however, using an algorithm of varying combinations of intralesional anti-inflammatory agents in various combinations, concentrations and amounts. Make sure that you consult an experienced, board certified cosmetic dermatologist. Beset of luck.

Leonard Grossman, MD · Answer

the bags that you have are clearly caused by the hyaluronic acid filler which was injected in the under eye area. Hyaluronic acid fillers are a gel which can be compressed and moved around the treatment area especially in the area like the lower eyelid were the skin is very thin. The muscle which goes around the eye is like a sphincter which squeezes while protecting the eye. This action causes the hyaluronic acid filler to move towards the area where there is no muscle and that area is right next to the nose. You should have your filler dissolved with the use of hyaluronidase and if there is still a hollow area, I would repair that with the use of your own fat. Fat grafting in the hands of an experienced plastic surgeon provides natural and permanent results. I hope this helps and good luck from New York City plastic surgery.

Indents either side of nose after fillers. What is causing this and how can I get rid of it? (Photo)

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Indents either side of nose after fillers. What is causing this and how can I get rid of it? (Photo)

Answers (3)

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Everything you need to know about Hyaluronidase

Our mission is to create a world where every investment in modern beauty is Worth It.