Complications After Juvederm to Tear Troughs? (photo)

One week following treatment is way too early in my experience to rush to treat possible problems. There is still too much tissue swelling (edema) from the pin pricks and trauma of the treatment to be sure exactly what you are treating at this stage.

I typically advise patients to be patient and wait about a month before evaluating whether anything needs to be done in the event of a swelling such as in this case. At that point, if the swelling persists, a tiny amount of hyaluronidase, an enzyme that dissolves hyalruonic acid, can be injected in microdroplets directly into the bump to flatten it. The normal surrounding tissue is NOT affected by this. 

Juvederm UltraXC is my preference for treating tear troughs (that are not too deep )in my Upper East practice in NY. In my Israeli practice, I prefer Princess Filler for this purpose. For deeper tear troughs that require more lift, I use Restylane L. When dark circles are present, I add a bit of Radiesse, which is whitish in color, to help lighten the area.

Your photo reveals you have a thin mid face, so I can understand your desire for fillers in the first place. It appears that the product is a little superficial in the left tear trough area.  You may want to have that bit dissolved but in general you could use "More" volume  in your cheeks to fill them out.  This can be with dermal fillers, sculptra or  fat grafting which is natural looking and longer lasting

Tear Troughs are not easy!  A little goes a long way!  I didn't exactly understand when you were injected, however I would massage any irregularities as Juvederm is easily molded.  If it has been a few months, Hyaluronidase will dissolve the Juvederm.  I have never seen it dissolve the patients own tissue enough to notice. 

Thank you for your question. Juvederm is not the correct filler to be used in the tear trough area as it attracts a lot water and causes edema. The best filler for this area is Restylane as it is a thinner filler and attracts less water. Typically, I use cannulas for this area for safety and less bruising. I recommend following up with your injector as he/she may want to dissolve the filler with hyaluronidase. Best of Luck!
 

I certainly understand how you feel!  I have had filler there in the past, and had to have it dissolved.  Frustrating!  The skin is very thin in the eyelid area, and filler here is quite difficult to do well.  You need to wait another week to let the swelling resolve- maybe try some Bromaline (in pineapples) or Arnica to speed the swelling. I use Restylane in the tear trough, I do think it does better in this area.

Uphill,

Using fillers under the eyes is difficult to do well and requires a delicate hand and light touch. Juvederm is slightly trickier than its counterpart Restylane because after injection it does tend to absorb more moisture and swell more than Restylane, which can lead to puffiness and lumpiness under the eyes at first. I think it's fairly normal that even a week after your treatment with Juvederm you may have some swelling and bruising that is still working its way through. Gentle massage with a flat finger outward to press some of the fluid out of the area is probably fine, but try not to manipulate the Juvederm itself. Leave that to your doctor. As the swelling of the material itself recedes, any trapped lymph fluid may be able to escape the area more easily. Keep following up with your doctor.

This may just be normal swelling and bruising and you are well advised to wait before doing anything to treat this.  Mother nature often fixes these things but she requires a little time.  If the swelling were to persist, it would probably make sense for your doctor to inject hyaluronidase, which will remove most of the filler.  This will not damage your natural structures.

I have performed countless tear trough filler injections and have yet to see such significant swelling as you have described. It is indeed possible since the filler can bind water, but also because it may have plugged up your tear ducts. You may consider hyaluronidase treatment to reduce the amount of filler in the area. In the future, you may want to try a small amount of radiesse instead in this area as it doesn't bind fluid/expand.

The yellow color you are experiencing is likely the last stage of a bruise underneath your skin from hitting a vessel during the injection. It will go away shortly. Unfortunately due to its consistency and molecular structure, Juvederm isn't the ideal filler for tear troughs. Instead, I would recommend seeing a physician who is comfortable using Restylane or Radiesse, as these would be better suited for this anatomical region. 

Unfortunately, Juvederm around the tear trough area can have these complications.  It is very hydrophilic and pulls fluid into the treated areas resulting in puffiness.  Restyline may be a better option.  I would recommend treating with the hyaluronidase to dissolve the filler.  The enzyme will not result in loss of collagen.  Hope this helps!