Juvederm Voluma in tear trough, doctor said she did a 30% underfill, does this mean it wasn't all injected?

Question

Hi, I had juvederm voluma for my tear trough, the physician said she did a 30% underfill, now does this mean I didn't have all the 1ml injected? the results are significant however, I believe I could have a little bit more. thanks

Stephen Prendiville, MD · Answer

I would be very cautious about use of Voluma in the tear troughs.  Please bear in mind that there is no current FDA indication for tear troughs for any filler, but Voluma would be lower on most experienced injectors' lists in terms of preference.  My personal preferences include Belotero, Volbella, and Restylane, but all fillers in this area can have issues.  I am not sure what the 30% under-corrected remark is about.

Nelson Castillo, MD · Answer

Thank you for sharing your question and congratulations on your filler enhancement.  Your physician was likely referencing incomplete correction of your lower eye hollowness in order to minimize risk of being "over filled". Lower eyelids should be added to incrementally in order to produce a harmonious contour. Hope this helps.

Nirmal Nathan, MD · Answer

It sounds as if your injector undercorrected your tear trough by 30%, as HA fillers absorb water and can increase in volume...although Voluma is know to have very little water absorption. Generally, when I inject with Juverderm Voluma, I tell my patients "what you see is what you get". This is in contrast to Juvederm Ultra or Ultra Plus, where I will discuss things in terms of undercorrection.

Also, I would humbly advise you to be carefuly injecting Voluma in the tear troughs. It is a dense filler that is not meant to be used in shallow, thin skinned areas like the tear trough. This is not to say it can;t be used, but there are much better fillers out there for that purpose.

Hope this helps.

Sean Doherty, MD, FACS · Answer

I don't typically use Voluma to treat the tear trough. It's a bit too thick and can be problematic. The fact that you are happy with your results is great. I would encourage you to let things be. Underfilling this area is the right approach.

Jennifer Trent, MD, FAAD · Answer

The tear trough area is very tricky and delicate.  Underfilling the area is the correct way to approach treatment of the tear troughs. Always seek treatment from a qualified physician.

Kouros Azar, MD · Answer

Personally, I do not use Voluma in the tear trough area. It is a very thick filler designed for restoring volume to the mid-face and the area under the eyes is extremely delicate. This can be a bad combination. So, I would suggest that you leave things be and do not go back for more.

Alex Eshaghian, MD, PhD · Answer

Thank you for your question conjode. Voluma is a filler used to enhance the appearance of the face. Only your doctor can tell you how much was used. However, many doctors "underfill" areas with certain fillers such as Voluma. This means they add less than what appears necessary for full correction. The reason for this is that the filler draws water into the skin slowly and more fullness appears after a few days. We assess results using photography 2 weeks after a treatment to determine if further enhancement is desired. Please consult with a doctor for specific recommendations. Good luck!

Faiyaaz Kalimullah, MD, FAAD · Answer

Thank you for your question.  When most injectors refer to "underfilling" an area, they are indicating that they did not treat to full correction.  I would assume that your physician was able to treat your tear troughs to approximately 70% correction with 1cc of Voluma, and therefore did a "30% underfill."  This is why you are seeing significant improvement, but still could use a little bit more.  Please contact your physician if you have any additional concerns.  Best of luck!

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

I doubt she meant that she only used 70% of the syringe and that you have some left. This would be a very strange way of telling someone that. For clarification, please call the office. My assumption is that she means she didn't completely treat the area to what is called "full correction". She used the syringe she had which corrected you to 30% of what would be considered "full correction". In other words, if you want "full correction" you need to buy another syringe and get more filler put there. "This answer has been solicited without seeing this patient and cannot be held as true medical advice, but only opinion. Seek in-person treatment with a trained medical professional for appropriate care."

Juvederm Voluma in tear trough, doctor said she did a 30% underfill, does this mean it wasn't all injected?

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