Bulging Under Eye After Juvederm Injection in Cheeks /Botox in Brows

Question

I had an immediate reaction of swelling in the left tear trough area after Juvederm injection to my cheek and Botox to eye brows. There was a small bruise/swelling where she injected and swelling under the eye occurred on that side. Practitioner states it was likely caused by vessel irritation. One week later bruise is gone but swelling under eye remains, albeit slightly less. Looks like lymphatic fluid collection...any thoughts, suggestions? Going back in a few days for recheck. Thanks.

Ron Shelton, MD · Answer

The swelling could be a hematoma from the vein trauma, but usually this is slighlty tender and turns dark quickly. It might be displaced filler that occurred not after but during the procedure. Rarely the subcutaneous anatomy allows filler to move to an adjacent area as it is injected under pressure. That is why slow injection is helpful to minimize excessive product being displaced. If it doesn't appear to the doctor to be a hematoma, it can be injected with an enzyme, hyaluronidase, to dissolve excess Juvederm.

Young R. Cho, MD, PhD · Answer

Thank you for your question.  Swelling is possible everytime a needle penetrates the skin.  Having said that, I typically find that the degree of swelling varies based on the treatment and location.  For example, swelling after Botox is usually minimal (unless you bruise).  Juvederm in the nasolabial folds also has minimal swelling.  Juvderm in the lips, however, can result in a lot of swelling.  It's a good treatment to do on Friday so the swelling can be reduced by Monday.If you swelling persists, I would return to your injector as they may have irritated the lymphatics under the eye and causing a persistent swelling.

Kenneth D. Steinsapir, MD · Answer

This is over fill.  It can be from too much actual filler or too much water held in association with the injected filler product.  Generally this lower eyelid area is not optimal for Juvederm.  The beauty of Juvederm for inexperienced injectors is that the product is smooth-meaning that if you create a lump or bump, the product tends to smooth out.  This is not an ideal characteristic for the tear trough because for some individuals, this means that after treatment the product tends to collect at the top of the cheek.  The presence of a bruise means that you should give this perhaps one more week.  If the area is still too full, your injector should begin to adjust the product with the enzyme hyaluronidase.  If you injector does not feel comfortable making this adjustment, you are working with an inexperienced injector and need to find someone with a full range of skills which is essential if one plans to offer these types of services to the public.

Kris M. Reddy, MD, FACS · Answer

Based on the description it does not sound like an accumulation of excess product, but rather fluid accumulation. This will resolve itself slowly over the next couple of weeks. Continue to have the injector monitor the progress.

Ted Brezel, MD · Answer

The fact that it occurred immediately after the injection with bruising would indicate that that this was blood.  As you indicated the bruising has resolved which is going to resolve quicker than any fluid accumulation.  Fluid accumulation under the eye tends to persist longer than other areas because the tissue is loose in this area.  I would wait a period of time before injecting any hyaluronidase because I don't believe this is a matter of overcorrection.

Bulging Under Eye After Juvederm Injection in Cheeks /Botox in Brows

Answers (9)

Answer: Reaction in the tear through post injection into cheeks

Answer: Reaction in the tear through post injection into cheeks

Answer: Immediate swelling after Juvederm

Answer: Immediate swelling after Juvederm

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Bulging Under Eye After Juvederm Injection in Cheeks /Botox in Brows

Answers (9)

Answer: Reaction in the tear through post injection into cheeks

Answer: Reaction in the tear through post injection into cheeks

Answer: Immediate swelling after Juvederm

Answer: Immediate swelling after Juvederm

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Recommended reading

Everything you need to know about Juvederm

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