Dissolving Juvederm in tear trough gone horribly wrong! (Photo)

Question

I had restalyne injected in my tear troughs 1 1/2 years ago and juvederm about a year ago. I went 6 months ago to have it dissolved do to excess swelling and have been left with two lumps under my eyes that makeup just can't hide. I went back to my injector to get the rest dissolved and was told he couldn't do to to dissolving agent damaging my natural skin. . Can you please tell me if this looks like excess filler and should I seek a second opinion?

Alexander Rivkin, MD · Answer

Hello,Sorry to hear you are having a bad experience. It could be a little difficult to tell if there is still filler in there, if there may be a little bit of scar tissue, or if it is just a natural change of the face over the last few years.  I would recommend seeking a second opinion and bringing them some before photos as well. Sometimes a very small amount of steroid injected into the lumps can help to decrease them, but keep in mind there is a risk of dimpling if it is overdone.  Please make sure you do your research and seek a professional opinion who has experience with these types of issues.  Best of luck!Dr. Alexander Rivkin

Jason Emer, MD · Answer

It's difficult to tell from your pictures. I recommend getting a formal evaluation with a cosmetic dermatologist. If there is remaining filler, it can be reversed with hyaluronidase. It can take a series of treatments. See an expert. Best, Dr. Emer

John J. Martin, Jr., MD · Answer

Tough to tell from these pictures what is going on.  However if you think there is still some filler in there, it can be removed with more hyaluronidase.  Juvederm is not a good filler for this area since it will often cause long term edema.  And Juverderm can be tough to dissolve, and you often need larger amounts and/or multiple sessions to get rid of it.  We do not think that the enzyme damages your normal skin.

Alex Eshaghian, MD, PhD · Answer

Thank you for your question hmowens0127. I understand your concern. Juvederm is a hyaluronic acid filler designed to enhance the
appearance of the face. It is difficult to make an assessment without before photographs. However, fillers such as Juvederm can be dissolved with hyaluronidase if the desired results are not achieved. Multiple session may be necessary and I perform treatments every two weeks until the desired results are achieved. Sometimes the products move closer to the skin surface and hyaluronidase needs to be placed in that plane. I prefer using a softer filler such as Restylane or Volbella in this area. Please consult with a doctor for specific recommendations. Good luck!

R. Scott Yarish, MD · Answer

The tear trough is very sensitive to injectables and the problem you have is one I've seen multiple times from inexperienced injectors.  Hyelenex won't damage your skin and that would be the first treatment I would try in your case.  Failing that, a tiny amount of dilute steroid into the lumps would  help if there is actually scar tissue present.  The last resort would be direct excision using a tiny incision that would be virtually imperceptible.

Jeanine B. Downie, MD · Answer

Hi there, it is hard to figure out exactly what is happening with your filler under your eyes as I do not have a before picture.  I definitely feel you seek a second opinion about possibly removing more filler under your eyes. That is not an accurate statement about dissolving agents damaging your natural skin.  Sometimes people need multiple doses of Hyelenex to get what they are looking for.  My last thought is that the remainder of the circle/puff under your eyes may not be from filler alone, but could be a natural descent of the fat pad under your eyes which happens with the natural aging process. Good luck, Dr. Downie

Faiyaaz Kalimullah, MD, FAAD · Answer

Thank you for your question and for submitting your photos.  I'm sorry to hear that you are experiencing delayed swelling after Juvederm injections under your eyes.  Unfortunately, this is a fairly well-known complication of Juvederm injections in this area - Juvederm has a relatively high affinity for water, and can absorb up to 3-4x its volume in water over time.  This can result in delayed swelling under the thin and delicate skin under the eyes and in the tear troughs.  Consequently, experienced injectors never use Juvederm in this area.It's difficult to make exact recommendations without assessing you in-person, however, based on your photos it appears that you may have some residual filler under your eyes that needs to be dissolved.  Hyaluronidase should not damage your normal skin at all.  I would recommend scheduling a consultation with a cosmetic dermatologist or plastic surgeon for a second opinion.

Jeffrey Swetnam, MD · Answer

You should have no problem dissolving the filler with hyaluronidase. 
It is difficult to tell from the pictures but  you may want to consider treating the skin to improve the texture and color or a trans-conjunctival blepharoplasty with laser.

Leonard Grossman, MD · Answer

in my practice I discourage patients from receiving any kind of hyaluronic acid fillers in the tear trough as it almost always leads to problems such as yours. Since your treating physician is refusing to administer any more hyaluronidase I would encourage you to seek a second and maybe even a third opinion from a well-qualified plastic surgeon. It may be there are simply fatty bags under your eyes that need to be addressed. The best filler for the under the eye area hollowness and tear trough in my opinion is only FAT. Good luck from New York City

Michele S. Green, MD · Answer

It appears form your photos that you still have filler under your eyes.  I would get a second opinion and see if it can be dissolved.  Please keep us posted.  Best, Dr. Green

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