I have under eye swelling after Juvederm injections 18 months ago. Will Fraxel Laser be effective on eye bags? (photo)

Under eye swelling after juvederm injections greater than 18 months ago. Ive been told by a plastic surgeon its been too long to inject hyaluronidase. Another Dr said fraxel would be effective. I would love your opinion or any other suggestions to help with the swelling.

Doctor Answers 6

Juvederm and under eye bags

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I have successfully used hyaluronidase to dissolve filler that was injected years ago. If eye swelling started after receiving Juvederm in the tear troughs, it is reasonable to inject hyaluronidase regardless of the age of the filler. Juvederm is slightly more resistant to hyaluronidase than other similar fillers, so it may take more than one round of injection. If the swelling does not resolve, the swelling is unlikely to be related to Juvederm, and other options for under eye bags should be pursued. Fraxel can help with skin texture and tone, but will not fix bags under the eyes. A good de-puffing eye cream can help, but in some cases, the only solution for under eye bags is surgery.

Saint Louis Dermatologic Surgeon

Swelling under eye from Juvederm - do not treat with Fraxel.

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Fraxel will only lead to more edema. It is never too late for hyaluronidase. I've done it after about 3 years. You will need at least 2 treatments with 50-100 units per side each time. I use cannulas for this. 

Steven F. Weiner, MD
Panama City Facial Plastic Surgeon
4.9 out of 5 stars 75 reviews

Swelling from Juvederm

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Juvederm is a great product but very thick which makes it last longer and typically a product that I do not use under the eyes.  Hyaluronidase should dissolve the Juvderm.  Fraxel laser is excellent for sun damage, fine lines, scars, and wrinkles.  Fraxel will not be effective for this swelling.  Please consult with a board certified dermatologist with experience with these lasers and injections for the best cosmetic results.

Hyaluronidase Injections

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Fraxel is a resurfacing laser that would improve the condition of the skin but would be ineffective on the bag itself. If what you see is a herniation of the fat pad then you would need surgery to improve the bag. If this happened after Juvederm was injected then chances are it is the filler.

If it is filler under your eye then I would start with Hyaluronidase. I have injected Hyaluronidase into filler years after it has been injected with good results. Currently I use Hylenex it is the ONLY recombinant human Hyaluronidase available, vs the other options sourced from animals. I find Hylenex to be the most effective.

It is possible that you may need multiple injections of Hyaluronidase/Hylenenx to bring down the filler/swelling.

It is important to consult with a Board Certified Dermatologist with plenty of experience injecting Hyaluronidase.

Nissan Pilest, MD
Irvine Dermatologic Surgeon
4.6 out of 5 stars 23 reviews

Swelling and Under Eye Bags

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Hi Jennifer.  Strangely enough, it does look very puffy still after 18 months.  If this puffiness is from the Juvederm then Hyaluronidase will absolutely help.

If the bags are just heavy fat pads, then surgery will be required.  Fraxel will not help with the puffiness.

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.4 out of 5 stars 7 reviews

I have under eye swelling after Juvederm injections 18 months ago. Will Fraxel Laser be effective on eye bags?

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If the fullness is the result of Juvederm a hyaluronidase injection will still be highly effective, a Fraxel laser will not dissolve Juvederm.

No, Fraxel laser will not be effective on eyelid bags.  With respect to eyelid bags, that are not the result of a filler injection, laser treatments will not be effective because the Fraxel laser does not treat the "bag" (which is fatty tissue) but instead treats the overlying skin.  In short, the eyelid bag is much deeper than the depth the Fraxel laser can go safely go.

For a better understanding, think of the eyelid bag as a hernia much like a hernia in the abdomen or groin area.  Hernias in these areas can not be improved with lasers or creams, they require surgery to correct; this is similar to eyelid bags, they require surgery and are not improved long term with lasers or eye creams. 

More information about eyelid bags can be found on the link below.

I hope this helps. 

Timothy R. Miller, MD
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 74 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.