Under-eye swelling. What is needed here? Surgery or filler? (Photo)

Question

Hello! Can someone explain why my left under eye is so puffy while the right one is somewhat normal? What is needed here? Surgery or filler? I had filler placed throughout my face in the past and I'm afraid it will exacerbate it.

Chet Mays, MD · Answer

Thank you for your inquiry! Based on your photos, you would be a great candidate for a Lower Bleph to remove excess fullness. You have more fullness to the left side but this surgical option would leave both under eyes symmetrical. We would love to help you reach your goals. Schedule a consultation with a Board-Certified Plastic Surgeon so we can create a surgical plan for you!

Nelson Lee Novick, MD · Answer

Under-Eye "Puffy Pillows," or more correctly lymphedema (lymphatic obstruction) may occur, even years after treatment with an HA filler that was either inappropriate for the under eye area and/or injected too superficially into the thin, delicate tissue of the infraorbital area. The condition can be persistent or permanent. I have had gratifying results in treating patients who have come to me with this problem using an algorithm of varying combinations, concentrations and amounts of Intralesional anti-inflammatory agents. You would be wise to consult with a board certified cosmetic dermatologist filler expert and best of luck.

James R. Gordon, MD, FACS, FAAO · Answer

Thank you for sharing your question and posting your photo. It appears that your lower eyelid dermatochalasis (bags) are too prominent to correct with fillers. Please see an experienced oculoplastic surgeon for comprehensive consultation and guidance. 
Good luck!

Kenneth D. Steinsapir, MD · Answer

I would strongly recommend having all your hyaluronic acid filler removed from your face. This might take one or two rounds of enzyme. There is no reason on earth you need ultrasound or and MRI to determine where the product is. It pretty obvious where you are puffy. You do not need every nanogram of old filler removed so it is possible you will do well with a single enzyme session. This is generally a personal choice. Don't believe the nonsense out there that enzyme wrecks the skin. There is honestly no truth to this. The face does best settling after the enzyme service about a week before having a small amount of hyaluronic acid filler put back in just where it is needed. Less is more. There is no substitute for a detailed in person assessment and if you feel comfortable, enzyme treatment can be performed at the time of the consultation.

Zoran Potparic, MD · Answer

It is very difficult to evaluate your condition based on these photos. It appears that lower blepharoplasty may be option to consider. In person consultation with a board certified plastic surgeon is recommended.

Raja Mohan, MD · Answer

At-home treatments for puffy eyesYou can place anything cold, such as an ice pack, frozen bag of vegetables, chilled cucumber slices or refrigerated spoons, over closed eyes for a few minutes. Hemorrhoid creams: Some people pat over-the-counter creams designed for hemorrhoid treatment under their eyes.

Bugra Ipek, MD, FEBOPRAS · Answer

I would recommend lower eyelid blepharoplasty + fat grafting to infraorbital region. We can address your under-eye puffy look with the blepharoplasty. The reason for your ''eye bags'' is the herniated fat pads. with this operation we can take the herniated fat pads and repair the orbital septum to remove the puffy look. and you also have a hollow area under the eyelids. we will address this problem with fat grafting to infraorbital region, thus achieving a smooth cheek - lid junction.

Mats Hagstrom, MD (license on probation) · Answer

Issues in the anatomic area of concern can be a bit complex.
The transition between the lower eyelid and the upper midface is not at all easy or straightforward to assess or treat. fundamentally facial aesthetic issues are usually based on facial skeletal structure.
Insufficient projection of the midface can lead people susceptible to protrusion of lower eyelid fat, development of a tear trough and lack of volume in the mid face. Facial asymmetry is quite common.
During embryological development, the two sides of the face develop independently from each other and eventually fuse in the midline.
Some people are prone to this fullness in the lower eyelids, and it is possible to have it developed on one side, but not the other. The problem is fundamentally based on bone structure, though soft tissue solutions are often applied.
The problem can be treated with volume restoration, using fillers, fat grafting, midface lift, or implants.
Removal of the excess volume can be done with a lower eyelid blepharoplasty.
There are a lot of variables to take into consideration and providers may have a different solutions on how to treat it.
As I mentioned earlier, it’s not always straightforward or easy but good treatments are definitely possible.
I highly recommend you were lying in person consultations and avoid virtual consultations whenever possible.
Consider consulting with oculoplastic surgeons, facial plastic surgeons, or plastic surgeons in your community.
Expect different providers to possibly have different recommendations.
This is common in situations that are complex.
Best,
Mats Hagstrom MD

Under-eye swelling. What is needed here? Surgery or filler? (Photo)

Answers (8)

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