Lumps and hollows after Juvederm. Any suggestions? (photos)

Had juvederm injected 2 days ago to tear troughs, I look haggard! Have lumps on eyes and skin on cheeks and eyes looks deflated! My doc reassures me that it will settle but I'm really down and upset at the minute, is this normal? Should I give it more time?

Doctor Answers 15

Fillers do take time to settle, and addressing you eyelid-cheek area will improve the look of your eyes and cheeks as well

Thank you for your question. I understand you had Juvederm placed under your eyes for tear trough treatment, and you’re now feeling concerned over the appearance of lumps and hollows in the area, as well as sunken cheeks. You’ve expressed this concern to your doctor, and they advised you to let the material settle first.

I can certainly help you with your concerns. Just a bit about my background — I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic surgeon, practicing in Manhattan and Long Island for over 20 years. I was first trained in eye surgery, before specializing in cosmetic and reconstructive surgery of the eye area, with the goal of helping improve the appearance of people’s eyes.

Based on your photos, it seems that you are dealing with several concurrent issues, of which the under eye hollows seems to be what bothers you most. In my practice, it is important to spend enough time to hear people’s concerns, understand where they’re coming from, and also understand their treatment priorities in order to effectively pinpoint what about their appearance bothers them most. Sometimes, people tend to zone in and magnify certain parts of themselves that they don’t like, so it’s also important to look at the big picture.

When it comes to under eye hollowing, it is important to define the cause — is it genetic or is it due to facial aging? With facial aging, keep in mind that you’re dealing with global loss of volume, bone, muscle and fat throughout the face.

In cases such as yours, most of the time, we can approach this in two different ways. The first is similar to what your doctor did, and that is to use a filler, which I prefer Restylane for under the eyes, which I combine with platelet-rich plasma (PRP) for under eye hollowing. Platelet-rich plasma is a concentration derived from your own blood that contains healing and growth factors that improve collagen and blood supply in the skin. Since your skin does look somewhat thin, you can benefit from this synergy of volume correction and skin quality improvement.

Another approach we do is by means of a procedure called the Y Lift™. In this procedure, we use a filler, such as Juvederm Ultra Plus or Voluma, and we place it deep in the cheekbone area in order to provide a type of cheek lift. A cheek lift with the under eye hollow being corrected is a very nice combination, and helps with your issue of your cheeks looking deflated to you.

I think your doctor was correct in advising you to wait, since it isn’t unusual for people with thin skin to have these types of lumps. In our practice, we usually follow-up with our patients after two weeks, as this is how long it takes for the material to settle within the body and the muscles, and also to massage the material into its contour. This is also the time to see if additional filler is needed for further enhancement.

I suggest you meet with your doctor and discuss this type of approach, as well as a way to get the whole area to look good instead of just the isolated area of the tear trough. It’s important that we look at the whole picture and not just the little areas.

I hope that was helpful and I wish you the best of luck!

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New York Oculoplastic Surgeon
4.3 out of 5 stars 61 reviews

Lumps and hollows post hyaluronic acid injections

All HA injections can lead to swelling, bruising, and lumpiness in the injected areas, especially for the first two to three days after injection.  Gentle massage of the areas is warranted to help resolve the swelling and distribute the materials evenly.  Lumps that persist past a few weeks should be evaluated by the surgeon.  Persistent lumps may be due to inadvertent injection into a closed space such as a fat pad or muscle.  Injections that are too superficial may also cause lumpiness.  Persistent lumps may be treatable with hyaluronidase. As always, the skill of the injector is of paramount importance. 

F. True Lansden, MD
Key West Plastic Surgeon
5.0 out of 5 stars 3 reviews

Lumps under the eyes after filler

Lumps and bumps after filler injection can happen; swelling immediately after filler may make things look worse than they actually are.  It is a good idea to wait for resolution of swelling before proceeding.  However, the tear trough area is an area that is commonly injected incorrectly with filler being injected too superficially, wrong filler being chosen, or too much filler injected causing swelling of the lids.  It is important to seek out an expert injector; paying a little more will go along way to better, more consistent results.

Kyle Coleman, MD
New Orleans Dermatologic Surgeon
5.0 out of 5 stars 7 reviews

Juvederm Under Eyes

This is not my preferred filler in this area however i would wait 2 weeks and if you still have these issues you should have the filler reversed.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.9 out of 5 stars 165 reviews

Uneven Injections from Juvederm

I am so sorry for your trouble.  I would definitely wait at least 10 days to see the effect of the injection before I would attempt to dissolve it or put more product in.  Please keep us posted.  Best, Dr. Green

You need to give it time

i strongly disagree with Dr. Weiner comments below. Both Restylane and Juvaderm are hyuralonic acids and they are very similar, though they are made by different companies. Juvaderm NEVER lasts years so i have no idea what he is talking about. Based on the photograph, i think it is absurd that he thinks he can tell it was injected too superficially. It is almost impossible to tell anything from that photograph. 

you should relax and give it several weeks. It is not uncommon at all, after Restylane or Juvaderm is injected into the tear trough, to go through a period, where it looks worse before it looks better. Remember you can massage any lumpiness. The most important thing is just to be patient and not drive yourself crazy.

good luck
david berman md

David E. Berman, MD
Sterling Plastic Surgeon
4.9 out of 5 stars 82 reviews

Juvederm injections

Please wait for two weeks until any swelling or bruising has subsided.  You will then be able to see your final result and you may be happy.  Juvederm may cause puffiness afterwards so a small amount can be removed if necessary.  Tear troughs should be treated by an experienced cosmetic dermatologist or plastic surgeon.

Martie Gidon, MD, FRCPC
Toronto Dermatologist
5.0 out of 5 stars 21 reviews

Lumps after Juvederm to tear troughs

Even  after waiting the 10 days that everyone is saying, you won't be happy. Juvederm is absolutely the wrong product to inject here. It can lead to prolonged swelling that can last years. It looks like the product was injected too superficially as well. This should be dissolved  with hyaluronidase and replaced with Restylane. See my link please.

Steven F. Weiner, MD
Panama City Facial Plastic Surgeon
4.6 out of 5 stars 27 reviews

Lumps and hollows 2 days after juvederm injection

2 days is not nearly enough time to judge the result of injections.  That having been said, I do not believe that Juvederm is the best product to use in the tear trough region.  I unfortunately see large numbers of patients who develop undesirable swelling in the tear trough region after juvederm injection.  Best of luck.

Brian Biesman, MD
Nashville Oculoplastic Surgeon
4.8 out of 5 stars 41 reviews

Tear Trough

You certainly need to wait to judge or correct.  In 2 weeks you will be able to tell what it will look like.  I do not like Juvederm in the lower lids, prefer Restylane- no exceptions to that for me.

It can be reversed, looks too low to me, but of course hard to tell at this point.  

The lower lid is the most non-forgiving place for filler, the skin is very thin, and Juvederm is not as smooth as Restylane for the lower lid.  

If it were me I would massage it, maybe even try some warm compresses.

It is not permanent, remember that- can be corrected if need be.

Melanie L. Petro, MD
Birmingham Facial Plastic Surgeon
4.7 out of 5 stars 29 reviews

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