I need advice on my next step for under my eyes. I have two issues, sun spots and puffiness. Any suggestions? (photo)

I should add I have had Botox 25 ccs between the brow and 15cc's by my temple for crows feet. I love my results. I had I syringe of voluma filler put in my cheeks in January which I like, but ever since then my issues with my eyes look worse. I am not sure if this is a laser issue or a filler issue but I need advice. I was planning on doing laser after summer for sun damage but not sure if I want to wait.

Doctor Answers 13

Puffiness under Eyes after Voluma

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Nice results with the BOTOX.  If you have always had puffiness under the eye, a blepharoplasty may be helpful. If the puffiness is worse since the injection, vitrase, can help smooth the puffy area if it is due to the voluma or blockage of some of the lymphatic channels.
Laser resurfacing is a nice tool for improving the sun damaged skin around the eye. I think you are wise to consider it at the end of summer. In the meantime, use sun screen and you could use some lightening agents-retina, hydroquinone, etc. Just be aware these can make you more sensitive to the sun.

Atlanta Facial Plastic Surgeon
4.6 out of 5 stars 35 reviews

Swollen Eyes and Best Treatment

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It appears from your photo that the Voluma injections made your eyes worse.  I would consider having it dissolved with Vitrase.  Also you appear to be a candidate for blepharoplasty as other non-invasive procedures will not solve this problem. Botox would not be the solution here either. Best, Dr. Green

Malar Bags and Festoons -- Lasers and RF are Best

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you need laser treatments and fillers for improvement. Please see an expert who treats the eye area frequently.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 207 reviews

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Botox and Voluma made eyes worse

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This is frankly poor Voluma injection. It needs to be dissolved with hyaluronidase. Best results would be with surgery. Non surgical correction would be midface volume with Voluma, Lyft, or Sculptra. Tightening the lower lid can be done with ablative laser or Infini.

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Lower eyelid puffiness and sunspots

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I would ask your injector if the Voluma was placed in the tear trough (lower eyelid groove) as well as in your cheeks.  If it was, and you are experiencing excess fullness there, then ask your injector to dissolve some of this with hyaluronidase, which can reverse the filler in this area.  Voluma is best injected in the cheek region and not in the tear trough region.   A thinner filler such as Belotero may be a better choice for the tear trough region, so it does not clump as much.  A surgical option would be a lower lid blepharoplasty with fat grafting, which can permanently correct the lower eyelid groove.  I would recommend that you consult with a board certified plastic surgeon in person to determine your needs. 

Cindy Wu, MD
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I need advice on my next step for under my eyes. I have two issues, sunspots and puffiness. Any suggestions?

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Thank you for your question. In some cases Botox injections around the crows feet can highlight puffiness under the eyes. Speak with your injector on how to avoid this. Consider speaking with a board certified surgeon regarding a under eye blepharoplasty and laser treatments to remove spots. 


Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 521 reviews

Puffy lower lids

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kerrileary, I would recommend a "SOOF lift blepharoplasty" with ablative CO2 resurfacing of either your lower lids or your full face. I have been using this technique for over 20 years and in experieinced hands it is safe and extremly effective. Seek out a surgeon familiar with this approach. See someone that does only faces! Good luck!

M. Sean Freeman, MD
Charlotte Facial Plastic Surgeon
4.7 out of 5 stars 55 reviews

I need advice on my next step for under my eyes. I have two issues, sun spots and puffiness. Any suggestions?

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Thank you for your questions and photographs.  The first piece of information we would need to know is where your injector placed the Voluma.  Voluma should not be placed into the tissues of the lower eyelid as it can cause puffiness and lead to subpar results. If it has been over 2 weeks since placement I would advise dissolving the filler material to return you to your pre-injection appearance.  I do agree that Voluma would be an excellent non-surgical option for you and would recommend seeing an expert injector who can accentuate your cheek region in order to also benefit your lower eye appearance as well as the "smile lines" around your mouth. 

Nelson Castillo, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 80 reviews

Fillers Can Work Well For Camouflaging Under Eye Bags

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Frankly, just yesterday I saw a 40 year-old new patient who came to me with very much the same story: Botox to the forehead and glabella three months earlier that she was quite pleased with, and the presence of those bags below the eyes following treatment somewhere in the upper cheek/lower lid region with Juvederm Ultra Plus.

In my patient's case, a slight bluish tinge in the undereye outpouchings, suggesting the unwanted Tyndall Effect from injection of the Juvederm too superficially in the delicate tissues of the region.  Moreover, my patient also showed evidence of volume depletion in the mid-cheek region, as seems also evident in your photos.

I did consider the use of hyaluronidase to the bags. However, I suggested to my patient that we first revolumize the hollowed, deflated mid cheek region with Voluma XC with the idea of not only restoring a more youthful contour and shape, but also of lifting the cheek and providing sufficient projection so as to secondarily stretch and improve the infraorbital outpouching. To our mutual delight, this tailored approach worked and my patient was thrilled with the more youthful facial contour and the diminution of the unsightly under eye bulges. She opted not to have the hyaluronidase.

I suggest that you seek a second opinion and treatment by a board certified aesthetic physician with experience and expertise in treating the periorbital regions, which is not a region that should be left to the hands of novice injectors accustomed to treating simple smile lines with ordinary fillers. Make sure to ask to see his/her before and after photos.  Best of luck to you.

Nelson Lee Novick, MD
New York Dermatologic Surgeon
4.9 out of 5 stars 33 reviews

I need advice on my next step for under my eyes.

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The swelling/puffiness under your eyes looks "tubular". If Voluma was injected on this area, then it might be causeing the new puffiness. We need pictures of you before the Voluma to see if there was (or not) puffiness there before. If the Voluma is creating the problem, then you will need to consider dissolving some of it in that area.

You have some amount of sun damage and wrinkles that can be helped by fractional CO2 resurfacing or chemical peel. If the puffiness under your eyes is not due to the Voluma, then consider a lower eyelid blepharoplasty to remove the excess fat.

Please consider consulting with a facial specialist board certified in Facial Plastic Surgery.

Hope this helps,
Dr. Gus Diaz

Gustavo A. Diaz, MD
Charlotte Facial Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.