Getting lower blepharoplasty after Juvederm

I got Juvederm under my eyes a couple of days ago and I really like it, but I have decided I want to go ahead and do lower blepharoplasty next May (9 months from now). Since I will still have some Jjuvederm left under my eyes, do I need to wait longer? The timing is just better for me in May. Can the surgeon I see remove the Juvederm so that he can see what I need? I will be using an oculoplastic surgeon instead of the plastic surgeon that did the Juvederm.

Doctor Answers 8

9 months should be enough time

By nine months most of the juvederm will have resorbed.  However, most plastic surgeons and oculoplastic surgeons will have you wait longer if the juvederm is still present.  It cannot be removed in surgery.

Corpus Christi Plastic Surgeon
5.0 out of 5 stars 13 reviews

Getting lower blepharoplasty after juvederm

Your question has two components. the first one has to do with the Juvederm placed in the lower eyelid region, The second one has to do with the implication that somehow occuloplastic surgeons are superior to plastic surgeons and facial plastic surgeons when it comes to cosmetic surgery of the eyelids. While you may not have intended to state that, it is implied by your question since you seem unhappy with the result of the juvederm and specifically state you are not going to that surgeon for surgery but instead are going to an occuloplastic surgeon whom you seem to perceive as a specialist in the area of cosmetic eyelid surgery in contrast to the plastic surgeon. Let me address both issues. First of all I agree with the two earlier opinions that hyaluronidase can be used to remove the filler but the only issue is that it frequently does not remove it all and sometimes requires multiple treatments. I have quit putting any type of filler in the nasojugal groove for that reason as the benefits do not outweigh the risks. I now use a procedure I developed in 2007 and published in 2013 in the Journal of Plastic and Reconstructive Surgery called "lateral access recontouring" which is a minimal access procedure which corrects the contours without making an incision either in front or behind the eyelid which in my experience is the first lower lid procedure I have used that has been free of the risk of lower lid retraction. If you would like further information you can google "lateral access recontouring of the lower eyelids". In regards to the latter issue, keep in mind most of the scientific literature in regard to cosmetic eyelid surgery was developed and published over the years by plastic surgeons and later facial plastic surgeons and occuloplastic surgeons, and many plastic surgeons continue to be world leaders in cosmetic eyelid surgery. Plastic surgeons ( and facial plastic surgeons) train , and are "specialists", in cosmetic principles of the entire face comprehensively which includes not only the eye region but also all the regions around it which many times relate to and need to be addressed along with the eyes. For example, I perform an endoscopic brow lift with at least 80% of my blepharoplasty procedures since from an overall aesthetic standpoint ,brow ptosis is very common, especially lateral ptosis. When an endobrow is performed first it usually decreases the amount of skin necessary to be removed form the upper lid since the eyebrows are raised slightly. 
I am in no means  implying that plastic surgeons and facial plastic surgeons are superior to occuloplastic surgeons either . The fact is that it really boils down to the individual surgeon and their skill since all three specialties have the training to supply the patient with excellent results. The idea that the best surgeon for any given area of the body is a surgeon who ONLY works on that area is erroneous as it is primarily a matter of experience and skill rather than just being limited to that area.The best orthopedic hip surgeon I know also does shoulders and elbows and even fixed my son's broken leg. So, be sure to read the reviews about individual surgeons on multiple websites and get a feeling for the overall trend of reviews ( remembering that even the Ritz Carlton gets an occasional negative one) and be sure to talk to former patients before you jump in. Former patients that you speak to and lay eyes on are the best. I hope this is helpful. 

Grady B. Core, MD
Birmingham Plastic Surgeon
4.6 out of 5 stars 12 reviews

Lower blepharoplasty after eyelid filler injection okay

You should be able to still have lower blepharoplasty after filler injection. The surgeon can melt the filler before surgery and the rest will go away with the surgical procedure. Technique of blepharoplasty matters too.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 72 reviews

Getting cosmetic lower eyelid blepharoplasty after filler injections.

This is completely fine to pursue.  However, hyaluronic acid fillers can last for years and they can also produce some lower eyelid and upper cheek area swelling.  Therefore it is best to dissolve the filler with hyaluronidase enzyme, which can be injected into the lower eyelids.  This is very safe and will under most circumstances "reset" your eyelids back to their original shape, contours, and appearance.  I would wait a few weeks to month after the injections before undergoing surgery to be sure that no further changes will occur that could effect the surgical planning or result.  Best regards.

John R. Burroughs, MD
Colorado Springs Oculoplastic Surgeon
5.0 out of 5 stars 14 reviews

Blepharoplasty after Juvederm

Talk to your Oculoplastic surgeon before you have the Juvederm dissolved. Two thoughts - if the Juvederm is totally out of the realm of the surgery (supraperiosteal along the zygoma - Voluma), not on the orbital rim, it may not be in the way or interfere with surgical decisions. If it is in the surgical zone, then it can be visualized and removed directly without the risk of losing your natural hyaluronic acid secondary to hyaluronidase injection. I have done surgery on eyelids with Juvederm Voluma present (over the zygoma) and it has not interfered with the eyelid outcome or intraoperative decisions regarding removing fat or repositioning the fat pads. In my opinion, you do not have to postpone surgery for this. Best wishes.

Sara A. Kaltreider, MD
Charlottesville Oculoplastic Surgeon
5.0 out of 5 stars 7 reviews

Eyelid surgery after fillers

It is acceptable to undergo a blepharoplasty procedure after filler placement.  Its best to have the filler reversed with hyaluronidase several weeks prior to the elective cosmetic eyelid surgery.  Choose your eyelid surgeon based on extensive experience producing natural results.  

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 reviews

Lower blepharoplasty after juvederm

I would recommend dissolving the fillers a few weeks before surgery for the best surgical results. I have seen cases where Juvederm has lasted years under the eyes. Good luck. Best, Dr H 

Sanaz Harirchian, MD
Houston Facial Plastic Surgeon
4.9 out of 5 stars 19 reviews

Lower Blepharoplasty After Filler

Great question!  Some patients can keep filler in the lower eyelid area for years.  When you go for your pre surgical evaluation let your plastic surgeon know you have filler.  Prepare them ahead of time and they can inject hyaluronidase to the lower eyelid area to dissolve the filler at your appointment.  You will need to be seen again to have an evaluation without filler to evaluate fully for the surgery.  Good luck!!!

Paul E. Goco, MD
Nashville Facial Plastic Surgeon
4.4 out of 5 stars 7 reviews

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