I’m only 32 and have noticed these shadows and puffiness under my eyes ever since getting juvederm filler a couple years ago. I have since had it removed but the puffiness persists. These shadows make me look so tired all the time- what could be done to correct this? I have Done a round of Morpheus 8 in hopes to tighten the area but didn’t see a difference. Thanks in advance for your professional advice!
Answer: Two issues Thank you for reaching out with your concerns. From your description and the photo, it seems that you are dealing with both pseudoherniated fat pads and malar edema, which can contribute to the puffiness and shadows under your eyes. To address these issues comprehensively, a combination of treatments may be considered. For the pseudoherniated fat pads, a surgical procedure known as lower blepharoplasty could be effective. This procedure involves repositioning or removing the excess fat causing the puffiness, and adjusting any excess skin. However, addressing malar edema requires a different approach. Laser treatments can indeed help improve edema by promoting lymphatic drainage and reducing inflammation. Antihistamines can be beneficial since the edema is histamine-mediated, not necessarily due to allergies. If you have had filler in the past to this area, dissolving the filler may help (and then undergo fat grafting to restore volume if desired). Considering your desire to avoid prolonged treatments, a surgical approach might offer more immediate and lasting results for the fat pad issue. However, for the malar edema, a combination of laser treatments, antihistamines, and possibly hyaluronidase injections (such as Hylenex) could be explored to help manage the edema. It's important to consult with a skilled facial plastic surgeon who can tailor a treatment plan to address both concerns effectively while taking your preferences into account.
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Answer: Two issues Thank you for reaching out with your concerns. From your description and the photo, it seems that you are dealing with both pseudoherniated fat pads and malar edema, which can contribute to the puffiness and shadows under your eyes. To address these issues comprehensively, a combination of treatments may be considered. For the pseudoherniated fat pads, a surgical procedure known as lower blepharoplasty could be effective. This procedure involves repositioning or removing the excess fat causing the puffiness, and adjusting any excess skin. However, addressing malar edema requires a different approach. Laser treatments can indeed help improve edema by promoting lymphatic drainage and reducing inflammation. Antihistamines can be beneficial since the edema is histamine-mediated, not necessarily due to allergies. If you have had filler in the past to this area, dissolving the filler may help (and then undergo fat grafting to restore volume if desired). Considering your desire to avoid prolonged treatments, a surgical approach might offer more immediate and lasting results for the fat pad issue. However, for the malar edema, a combination of laser treatments, antihistamines, and possibly hyaluronidase injections (such as Hylenex) could be explored to help manage the edema. It's important to consult with a skilled facial plastic surgeon who can tailor a treatment plan to address both concerns effectively while taking your preferences into account.
Helpful 2 people found this helpful
Answer: Eye puffiness after filler injections Hello. Thank you for your question. Your situation is unfortunately one that is very common and I frequently see. HA fillers such as Juvederm, even though they are supposed to be temporary, they never fully go away. There is an inflammatory reaction/fibrosis resulting from chronic lymphatic obstruction to the area that was injected. Just dissolving this often does not do the trick. I usually recommend a combination of lower eyelid bag removal plus nanofat injection to the area and +/- CO2 laser. Hope this helps! Paul D. Durand, MDFacial Plastic Surgery ExpertMiami, Florida
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Answer: Eye puffiness after filler injections Hello. Thank you for your question. Your situation is unfortunately one that is very common and I frequently see. HA fillers such as Juvederm, even though they are supposed to be temporary, they never fully go away. There is an inflammatory reaction/fibrosis resulting from chronic lymphatic obstruction to the area that was injected. Just dissolving this often does not do the trick. I usually recommend a combination of lower eyelid bag removal plus nanofat injection to the area and +/- CO2 laser. Hope this helps! Paul D. Durand, MDFacial Plastic Surgery ExpertMiami, Florida
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March 27, 2025
Answer: Juvederm may last longer than expected in the under eye area. Additionally, sometimes the dissolving enzyme is not helpful for undoing the effects of temporary gel fillers. Please consider Consulting with another reputable specialist so you can get a second opinion. I hope this helps. Sincerely, Dr Joseph
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March 27, 2025
Answer: Juvederm may last longer than expected in the under eye area. Additionally, sometimes the dissolving enzyme is not helpful for undoing the effects of temporary gel fillers. Please consider Consulting with another reputable specialist so you can get a second opinion. I hope this helps. Sincerely, Dr Joseph
Helpful
February 10, 2025
Answer: Best Solution for Persistent Under-Eye Puffiness Thank you for reaching out and sharing your concerns. Based on your description, it sounds like this is primarily a genetic issue, rather than one caused by fillers or skin laxity. Even at a young age, the three fat pockets in the lower eyelid can protrude through the orbicularis muscle, creating persistent puffiness and shadows under the eyes. The most effective solution in your case would be a lower blepharoplasty, specifically a transconjunctival approach. This technique allows us to remove or reposition the fat pockets without any external incisions, preserving the natural structure of your eyelids. Since you don’t appear to have excess skin, this would be an ideal option to correct the issue while maintaining a youthful, natural look.
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February 10, 2025
Answer: Best Solution for Persistent Under-Eye Puffiness Thank you for reaching out and sharing your concerns. Based on your description, it sounds like this is primarily a genetic issue, rather than one caused by fillers or skin laxity. Even at a young age, the three fat pockets in the lower eyelid can protrude through the orbicularis muscle, creating persistent puffiness and shadows under the eyes. The most effective solution in your case would be a lower blepharoplasty, specifically a transconjunctival approach. This technique allows us to remove or reposition the fat pockets without any external incisions, preserving the natural structure of your eyelids. Since you don’t appear to have excess skin, this would be an ideal option to correct the issue while maintaining a youthful, natural look.
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December 3, 2024
Answer: Under eyes puffiness in your 30's Although most women do not begin to see signs of lower eyelid "puffiness" until their mid-40s, oftentimes it can begin in the late 20s. Several factors come into play. The first are genetics. It is not unusual that either mom or dad went through similar issues early on. The second would be the appearance of darker skin of the lower lid. The photo submitted does not have even lighting and therefore it does not accurately reflect the condition. I would encourage you to explore eyelid surgery that can often be done through a tranconjunctival approach. Good luck.
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December 3, 2024
Answer: Under eyes puffiness in your 30's Although most women do not begin to see signs of lower eyelid "puffiness" until their mid-40s, oftentimes it can begin in the late 20s. Several factors come into play. The first are genetics. It is not unusual that either mom or dad went through similar issues early on. The second would be the appearance of darker skin of the lower lid. The photo submitted does not have even lighting and therefore it does not accurately reflect the condition. I would encourage you to explore eyelid surgery that can often be done through a tranconjunctival approach. Good luck.
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November 21, 2024
Answer: My lower lids are puffy after Juvederm injections Hello, Thanks for your question. Some patients develop lymphatic obstruction after tear trough/lower eye lid filler as the filler gel blocks the normal drainage of swelling around the lower lids. It's good that you had it dissolved. You may still have some long term damage from the injections. Here are some options to attempt to help improve your situation: 1. Radiofrequency eyelid contouring (RF) 2. Fat transposition lower blepharoplasty to reposition fat over the inferior orbital rim to fill in the hollows with your own vascularized fat 3. Transconjunctival lower blepharoplasty to remove excess lower lid fat and midface microfat transfer along with lower eyelid laser resurfacing for skin tightening Each of these options come with their pros and cons. A consultation with a board-certified plastic surgeon or facial plastic surgeon can help you pick the appropriate procedure for yourself. Good luck! Dr. Shah
Helpful
November 21, 2024
Answer: My lower lids are puffy after Juvederm injections Hello, Thanks for your question. Some patients develop lymphatic obstruction after tear trough/lower eye lid filler as the filler gel blocks the normal drainage of swelling around the lower lids. It's good that you had it dissolved. You may still have some long term damage from the injections. Here are some options to attempt to help improve your situation: 1. Radiofrequency eyelid contouring (RF) 2. Fat transposition lower blepharoplasty to reposition fat over the inferior orbital rim to fill in the hollows with your own vascularized fat 3. Transconjunctival lower blepharoplasty to remove excess lower lid fat and midface microfat transfer along with lower eyelid laser resurfacing for skin tightening Each of these options come with their pros and cons. A consultation with a board-certified plastic surgeon or facial plastic surgeon can help you pick the appropriate procedure for yourself. Good luck! Dr. Shah
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