Should I have lower eye surgery to repair a botched filler procedure? (Photos)

Question

In June I had under eye fillers. She used four syringes of Bellafill and all I had was a little hollowness in my tear troughs. She injected it above my cheekbones and now I have a huge bag over each cheek bone. I went back to her and she dissolved it with hydrolinaise and used several syringes. Now my bags are even worse. I went back to her and she injected one syringe of Bellafill half on each eye and I'm still stuck with these awful bags. what should I do ?

Rohit Seth, MD, MRCS(Ed), PhD · Answer

I would strongly advise against lower eyelid surgery being your solution to too much filler. This is far more invasive and can leave you with scars that you might not be anticipating as well as possible surgical complications. It would be better to have the area thoroughly assessed to ensure all the filler has been removed. You might consider a laser resurfacing procedure to help here instead which can help with tightening of the skin, once the filler has been dissolved adequately. I hope this is of help

Gregory Turowski, MD, PhD, FACS · Answer

Hello and thank you for your question. Based on your description and past experience, I do not recommend any surgery at the moment. You should consult with an expert and have all of your filler dissolved. It might take some time for swelling to go down and for the under eye area to be restored to its original appearance. In the future, you could consider a lower blepharoplasty to remove any excess skin and bags under your eyes. Also, if you have hollowing you are trying to correct, a fat transfer to the lower lids could be a good option for you. It is vital to consult and pick an expert in these procedures to ensure it is done correctly and safely. Please consult with a plastic surgeon and ask to see pictures of patients similar to you.

Philip S. Schoenfeld, MD, FACS · Answer

Thank you for your photos and procedure description.  My thoughts are as follows.  Four syringes of anything into the eyes is too much.  Period.  Bellafill will not dissolve with Hyaluronidase as it is not a hyaluronic acid and due to the high incidence of potential injection complications following lower eyelid injections  I would advise against the use of Bellafill in this area.  Finally, your issue is the oribitomalar ligament and not hollowness alone in the nasojugal area.  Seek out someone skilled in the anatomy of the lower eyelid and mid face and you can have the areas of concern to you corrected with filler injection to a reasonable degree.

Mehryar (Ray) Taban, MD, FACS · Answer

This is a difficult problem to evaluate without proper eye examination. The best treatment could be waiting vs camouflage filler (not bellafil) vs lower blepharoplasty with possible removal of some filler. Need personal consultation.

Kenneth D. Steinsapir, MD · Answer

The critical question is how much hyaluronic acid filler have you had in this area? The Hyaluronic acid fillers persist for perhaps 5 to 8 years.  After the first 12 months they typically just make generalize (unhelpful volume). If you have had 2 or more milliliters of hyaluronic acid filler under each eye over the past say 5 to 8 years, it could account for your current appearance. Most injectors simply lack the needed experience to properly dose this filler with hyaluronidase, the enzyme that breaks down the hyaluronic acid filler.  You might need as much as 300 units of hyaluroidase on each side.  It is improbable that your injector has dosed you with anything like this amount of enzyme.  Have this done if you have a history of hyaluronic acid fillers before seriously considering eyelid surgery. Bellafill is a bummer of a filler and can cause some nasty lower eyelid changes and there is no simple surgery that will address your issues.

Terry Hand, MD · Answer

Clarifying the issue, it appears that you have puffiness in both lower eyelids which is related to Bellafills injection.  If Bellafill is what was used; this is a combination of methyl methacrylate beads and collagen.  This is a permanent or semi-permanent material.  If this is the case, there is no injectable that I am aware of that would dissolve or remove this material.  Attempts at surgery to remove this material would probably result in a more significant distortion than you already have, therefore, I would not recommend it.  Small doses of injectable steroids may reduce inflammation and swelling making it less distorting.  Again, my recommendation is to avoid surgery.

J. David Holcomb, MD · Answer

Dear lbruce8883, Bellafill is not an HA (hyaluronic acid) filler and cannot be dissolved with hyaluronidase - perhaps it was Belotero that was used?  In any case it can take a while (months) for HA fillers to dissipate, even with appropriate use of hyaluronidase.  Sometimes repeated hyaluronidase injections are helpful. The submitted photos show significant remaining mid-facial volume loss that can be addressed with a different injectable HA or with other options such as Sculptra injections or fat grafting. Certainly lower eyelid surgery is not the answer for your concerns.  J. David Holcomb, MD

Curtis Wong, MD · Answer

and to truly have an objective evaluation, time must be allowed for your filler to completely disappear before consideration of any procedures.  Unsure why more filler was put back after attempts to dissolve it were done... it doesn't make sense.  But a very close evaluation of your pre-op photos should be done now as you may have had early malar bags that were accentuated with the filler and subsequent swelling.  But be patient and do not allow anyone to do surgical procedures on you at this time.  As mentioned, laser can tighten the skin to diminish the fullness but this is only temporary and also has its own risks.

Bradford A. Bader, MD · Answer

Bellafill is not a hyaluronic acid filler and so hyaluronidase would not dissolve this filler. It is important to see a physician who understands this basic principle. I would discourage any surgery to correct this problem. I recommend you seek consultation with an expert. Best of luck.

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