Preorbital edema, festoons, malar bags, fluid retention (Photo)

Question

Ever since I had fillers in 2017, I've had periodic edema. It's now a permanent fixture in my life. I wake up with fluid sacks most days. I've had several syringes to dissolve over the years. Crazy how trying to address an insecurity with an area can make it 1000x worse destroying quality of life. From every consultation I've had and everything I've read, I'm pretty sure I'm screwed ("that's a difficult area to treat"). Am I screwed?

Nelson Lee Novick, MD · Answer

This may very well be what has been recently described as post-filler under-eye "puffy pillows," which, in essence, are lymphatic obstruction or lymphedema. The use of hyaluronidase alone seldom is successful in these cases. However, I have had success using an algorithm of varying combinations, concentrations and amounts of intralesional anti-inflammatory agents. Make sure to consult with a board certified cosmetic dermatologist and best of luck.

Yao Wang, MD · Answer

Hi there, hyaluronic acid filler works like by sponge by absorbing all the fluid around it. Edema (swelling) from filler is quite common, especially in the lower eyelid area. This is because the skin on the lower eyelid is extremely thin, and the product can easily show. Depending on what you eat, how you sleep, the filler can become more or less swollen and vary day by day. Hyaluronic acid fillers are typically cross-linked - the more cross linking, the harder it is to dissolve, and the longer it remains in your body. There are some methods to try to dissolve this filler, but depending on what filler was initially used, it may take a few sessions. Hope this helps.

Camille Cash, MD · Answer

It's difficult to tell from the submitted photos what the best options are for you.  You may be a candidate for a lower blelpaharoplasty.  This procedure will remove excess skin as well as redrape fat to reveal a smoother under eye contour.  If the issue is festoons, you are correct that they are difficult to treat.  You may have improvement with lasers or Morpheus8 treatments.

Preorbital edema, festoons, malar bags, fluid retention (Photo)

Answers (3)

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