Under eye bags are more noticeable after Juvederm. Do you have any suggestions? (Photo)

It looks like your outcome has been less than ideal- this could be for multiple reasons... Depending on the medication that was used, it can be dissolved which occurs immediately!I place the filler with a cannula, NOT A NEEDLE, which greatly decreases bleeding and bruising- look for someone who does this. Find someone who exclusively specializes in faces. Hope this helps and God Bless!Dr. Robb

Thank you for your question. You submitted a photo, and describe you underwent Juvederm injection under your eyes to help the appearance of under eye bags, which made the situation worse. You also describe 4 days worth of bruising after the original injection so you had to miss work. It was suggested by the doctor to undergo surgery for under eye bags. You’re naturally questioning whether to do the injection, or what to do moving forward. You also describe developing an extra crease on your cheek.
I can share with you my guidance for patients who had very similar experiences who come to me from all over the world because of this new option of injectable fillers to help people with under eye bags. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. Helping people with facial appearance, the under eye area, and the eye aesthetics have been significant parts of my practice for this time. I recognize as an expert the challenges many patients have when they seek different options to help their under eye area.
In situations like yours, more often than not I have seen in situations at even 6 months, a year, or longer where a patient had an injectable filler under the eyes  they feel like their under eye bags worse, it’s generally helpful to first examine the patient. If there is any question if there’s filler present, often it can be elucidated when a person is looking upward. If it’s fat, it’s often easy to tell because the fat pockets push forward. That said, it’s very common for me to first dissolve any residual filler that’s present.
It is not unusual for a hyaluronic acid filler to remain much longer, and settle in different tissue planes in a way that creates this baggy appearance. Often it is very helpful to do that, then see what is the underlying anatomy. Often when people have under eye bags and get fillers, those under eye bags can become worsened. It’s about making the right choice for the right situation.
In my practice, if someone has mild puffiness under their eyes, and don't have time to have surgery, we can place filler in the tear trough area to try to blend that natural contrast between the puffiness and the depression.
However, if someone has significant puffiness,  the definitive procedure is to do surgery with a procedure called transconjunctival blepharoplasty. This is a procedure that’s routinely done in our practice using local anesthesia with LITE™ sedation, and  done from the inside of the eye to address the puffiness.
In your situation, your issue possibly has to be dealt with from different angles. I think there’s an opportunity, even though there’s a limited view, to look at your eye and in the cheek area, for some volume enhancement in the cheek area to maximize the appearance of the eyes. That’s something that can be discussed later after it’s clear what your true anatomy is.
One of the critically important things is to have a really good global understanding of the aesthetics of your eye and cheek area when you have a consultation. Often people get in trouble because if their cheek projection is relatively shallow, then placement of a filler in the tear trough without any support in the cheek creates kind of a ledge without support, and it ends up like a crescent moon puffiness because there is no continuity.
In the absence of a physical examination, it’s very important, before you make a decision about whether or not do surgery, is determine what is truly the cause of how you appear right now. The clue that speaks to me is you describe getting another crease in your cheek - to me that means there’s volume. That volume is either fat, filler, or a combination of both. In my opinion, generally my practice is to first use hyaluronidase to dissolve any filler in this area to reveal the true anatomy, then start from scratch.
Meet with your doctor who performed this and discuss this with them. If you’re not sure if you are as comfortable and confident about this doctor, then you can have another consultation.
To address the question about bruising after under eye filler, it is not unusual story. In my practice when I place under eye filler, I use blunt cannulas, which I rarely result in bruising. It’s a matter of technique and experience I think that helps every doctor do their procedure the way they feel most comfortable. In the scenario you’re describing, it would not be surprising if the doctor has done injections directly using a needle. When you do it that way, you can sometimes disrupt some vessels along the way. If you do multiple injections which is very common, you can understand why you had bruising. From that perspective, you have some options so doing filler under the eyes doesn’t always means bruising. No physician is immune to having patients who are bruised, but you work with probability. In my practice, the use of blunt cannulas and creating this type of fill in this area has worked out pretty successfully in the way I approach it, and bruising is minimized. I hope that was helpful, I wish you the best of luck, and thank you for your question.This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.

Dear NY,It appears from your photos that you have lower lid fullness that your Physician was trying to camouflage with filler. While fillers are helpful in many areas, they aren't the best for hiding lower lid bags. Surgery would be the best option for that condition. For the filler its best to dissolve that first prior to surgery. I hope this was helpful.