Please Help! What to ask in consult for surgical removal of under eye fillers? (No dissolver)

Since removing injectable fillers in the under eye area may necessitate an external scar, it may be worth trying the dissolving enzyme first if you had HA. Please consider re-asking your question with photographs. Thank you. Sincerely, Dr Joseph

1) Yes, it is still possible to dissolve filler at 5 months. The filler should have settled into tissues by then. However, the ability to dissolve it will depend on the type of filler used. Hyaluronic acid-based fillers can be dissolved using hyaluronidase.
2) Hyaluronidase is an enzyme that can dissolve hyaluronic acid-based fillers. It is typically injected into the area where the filler was placed. The exact technique will depend on the location and amount of filler to be dissolved. I recommend discussing this with your surgeon or aesthetician, as they will be familiar with your individual case.
3) Lower blepharoplasty techniques vary depending on the individual's anatomy and the surgeon's preference. Both transconjunctival (incision inside the eyelid) and transcutaneous (incision under the eyelashes) approaches are used. Non-surgical options include laser resurfacing or chemical peels to improve skin texture and tone.
4) Each procedure carries its own risks. Generally, non-surgical procedures are considered less risky than surgical ones, but they may not provide the same level of correction. It's important to discuss the risks and benefits of each option with your surgeon.
5) If the fillers in your malar (cheek) area are hyaluronic acid-based, then yes, a surgeon can use hyaluronidase to dissolve them. If another type of filler was used, it may not be as easily reversible.
6) Whether a future lower blepharoplasty is considered revisional will depend on if you've had previous eyelid surgery. Revision surgeries can be more complex due to changes in anatomy from the first surgery, but that doesn't necessarily mean they are riskier. The risk will depend on various factors, including your overall health, the surgeon's skill, and the specific procedure being done.
Please consult with your healthcare provider to get the most accurate answers for your individual case.

Without knowing specifically what filler was used under the eyes, I can only answer this in general terms. For HA fillers, which are natural, hyaluronidase, a natural enzyme, can be used to dissolve unwanted HA fillers. Treatment can be initiated immediately after treatment or as soon as desired. So, five months afterward is generally fine, as well. For semi-permanent fillers, such as Sculptra and Radiesse, or permanent fillers, like Bellafil, there is no equivalent enzyme to dissolve the filler.. (Sodium thiosulfate, sometimes recommended for Radiesse, has not overall proven itself to be particularly successful). I have had gratifying results in treating untoward reactions to permanent and semi-permanent fillers (and to the under-eye "puffy pillows," i.e. under-eye lymphedema/lymphatic obstruction) using an algorithm of varying combinations, concentrations and amounts of intralesional anti-inflammatory agents. Surgery to remove unwanted long-lasting fillers, runs the risk for the subsequent development of scars and stitch marks. So, caution is recommended when considering this option. You would be wise to consult with an experienced, board certified cosmetic dermatologist. Hope this helps and best of luck.