How Can I Correct Bad Juvederm Results Under my Eyes? (photo)

Question

Had Juvederm done under my eyes. After the 1st treatment - a very uneven result-one eye socket looked half an inch or more lower.Went in to correct it, and instead of a correction - ended up with a big protruding bulge under my right eye and a small "ridge" under my left. Went back asking the PA to fix this. He tried to move the Juvederm, which did nothing except cause a lot of pain, and told me to put ice on the area & use a bleaching cream. As I expected - zero result. How can this be fixed?

Harold J. Kaplan, MD · Answer

Hi Curious.  The good news is that the injections can be fixed.  We are in Los Angeles and use a product called Vitrase (hyaluronidase) which is an enzyme that can break down hyaluronic acid based dermal fillers such as Restylane, Juvederm and Perlane.  Once injected, the Vitrase will cause the Juvederm to dissolve and you should be back to looking the way you were previously.

	The bad news is it sounds like you found an injector that was not very experienced with this procedure.  It looks like he injected "over the muscle" which is a recipe for pouches and bags of product under the eye.  

	To learn more about proper injections techniques for the under eye area, check out our link below.  We also offer a free consultation.

Jerome Edelstein, MD · Answer

I recommend that it is worth having
your doctor try to break down the product with hyaluronidase. If it is still
present, then this will help to break it down.

Michael A. Persky, MD · Answer

Hi Curious in LA,

	It would be best to be evaluated in person to determine the best course to achieve your desired results.  To begin with, I would recommend an evaluation by a core trained aesthetic physician, not a PA.  Secondly, Juvederm attracts too much water when injected under the eyelids, we prefer to use Restylane only in this most delicate and unforgiving area.  Feel free to contact us if you wish to have an evaluation.  Good luck and be well.

	Dr. P

	Encino, CA

Steven Wallach, MD · Answer

If conservative massage did not help, you may want to dissolve it with Hyaluronidase and either leave the area alone or start over. You might want to consider surgical options to treat your lower lid cheek junction once things settle down.

Sam Goldberger, MD · Answer

The good news is that Juvederm is usually easily reversible with hyaluronidase. You should see an Oculoplastic surgeon who can perform this and also evaluate your eyelids to see if you have any predisposing conditions that led to this result. Good luck.

Tal T. Roudner, MD, FACS · Answer

Thank you for the question and pictures. I agree with you about having it corrected. You should see a board certified plastic surgeon that has experience with filler, eye surgery and hylaronidase use to dissolve HA's. It's important so he can correct the problem as well as evaluate your anatomy since from the pictures it appears you actually may benefit from a blepharoplasty procedure. It is a little difficult to know for sure but an experienced surgeon maybe helpful to analyze your condition.

	 

	Good luck

Steven Hacker, MD · Answer

When Juvederm is injected under the eyes, there is a risk of asymmetry as well as visible bumps and swelling. If this result occurs, then I would recommend you follow up with the surgeon who performed the procedure for advice on how to correct it. Sometimes hyaluronidase is appropriate and sometimes just waiting is the best form of treatment.

Jeffrey Schiller, MD · Answer

Hyaluronidase will dissolve the Juvederm and improve the situation significantly. I agree that generally a doctor is better than a PA at injecting, but injecting filler is more art than medical science and so it depends on the doctor's technical and aesthetic skills. And sometimes injections have unexpected results even with excellent technique.

Richard W. Fleming, MD (retired) · Answer

Juvederm is not the best product to use under the eyes because it is hydrophilic, meaning it attracts tissue water which can prolong the swelling. Restylane is much more predictable in this location. At the present time I suggest the injection of hyaluronidase which will dissolve the Juvederm. Find a physicia experienced in the use of fillers.

F. Victor Rueckl, MD (in memoriam) · Answer

I am sorry for your poor results and treatment. While it's hard to fully assess the situation without pre photos, I can say the following: 1. Juvederm isn't permanent, so most of the filler itself should go away within several months; 2. I don't prefer Juvederm under the eyes for many of the reasons you noted - ridging, discoloration, bulging, etc. Restylane is a much better under eye filler; and 3. The under eye area is extremely difficult to treat and really should only be done by exceptionally well trained physicians (not nurses, PAs, MAs, etc.) so please, in the future, visit a board-certified dermatologist or plastic surgeon who does the injections himself or herself. You can see a physician for a consultation about Hyaluronidase to have the remaining Juvederm dissolved, or you can wait it out. But your unfortunate situation, although not fun, isn't permanent and will resolve with time.

How Can I Correct Bad Juvederm Results Under my Eyes? (photo)

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