A month after steroids and dissolver there's no change in my under eye bags. How do I get rid of them after Juvéderm? (photo)

Question

I had Juvéderm places under my eyes using a cannula. A few days later a bag formed under the eye. The doctor prescribed steroids that did not change the bags. Then, they injected dissolvent. This too did not change the bags. It has been over a month now with no change.

Daniel Levy, MD · Answer

In general Juvederm ultra or ultra plus should not be used to treat the under-eye area because it is too hydrophilic, meaning it draws too much water into the tissues and risks creating a visible bubble or bag as you demonstrate in the photo. Prednisone does not help clear the bag, and steroids  should not be injected into this area because there is a risk of skin atrophy. Precise  injections of hyaluronidase, an enzyme that dissolves hyaluronic acid, works best. Good luck!

Mehryar (Ray) Taban, MD, FACS · Answer

Examination is needed to determine what is the cause of the remaining "bag". It could be filler, underlying eye fat, or combination. I have published a study discussing this issue.

Kaveri Karhade, MD · Answer

This will usually resolve with more hyaluronidase- it takes a relatively large amount of hyaluronidase to truly dissolve out the filler! Hope this helps

Yara Asbar, MD · Answer

Hi, thank you for your question. Injections of fillers in the tear troughs are very delicate in the sense that the immediate results are not always representative of the final results. Fillers attract water in general , but more so in this area. Sometimes, even if the injector is very careful and undercorrects the area to leave room for water retention, there can be more water retention than expected, which causes eye bags. Hyaluronidase (the product we use to dissolve the filler) is the best treatment in that case but sometimes it takes more than one treatment of hyaluronidase to get rid of the bags. Good luck!

Camille Cash, MD · Answer

I'm sorry to hear of the issues you've been experiencing.  It sometimes will take more than one treatment of hyaluronidase to fully dissolve the product.  I encourage you to return to your injector for an evaluation.

William Marshall Guy, MD · Answer

Hello Cool3483,Juvederm can be a great filler in the face in that it tends to pull in a lot of fluid, softening areas.  However, when injected in the tear trough as it hydrates it can lead to a bag formation.  Usually it just takes more hyaluronidase to get rid of it.  This is not likely a problem that steroids would correct.  I hope this helps and good luck.

Richard Ort, MD · Answer

You most likely need more hyaluronidase injections.  Juvederm is more resistant to degradation by hyaluronidase than other fillers so repeat treatment may be needed.  Most people don't use Juvederm under the eyes because it has a higher risk of swelling and puffiness than other fillers.Regards,Dr. Ort

Thuy Doan, MD · Answer

Thank you for your question. You may be experiencing chronic edema where the lymphatic system is either blocked or damage. Where your body is retaining the fluid and not draining. Taking an antiduretic (water pill) may help with this. This can take months to resolve! Slowly but surely. All the best, Dr. Thuy Doan. Atlanta

Martin Ray, MD · Answer

Hi Cool3483,
The swelling of your eye bag persisting at one month following Juvederm must be treated with enzyme to dissolve the remaining filler. Juvederm Volbella, Volift and Voluma are all cross linked to last and can therefore be stubborn to dissolve. Correction may take multiple treatments. The problem with eye bag swelling is being seen more frequently and is often inadequately treated. If not corrected, the swelling you demonstrate may persist. Even if it goes down on its own or with prednisone the swelling may reoccur periodically for years.
Please make an appointment with an experienced injector who can treat you with the proper injection of enzyme; please don't worry too much though, as proper management will give you a full recovery.

Jefrey Fishman, MD, FACS · Answer

I am sorry to hear you are not please with your treatment.
I will assume (although I don't know for sure) that you received your treatment to address the "circles under the eyes", also know as the tear trough area.  Unfortunately, swelling of the lower eyelids does occur after this treatment in some individuals.  Also unfortunately, it is more common with Juvederm than some other fillers for this area (Juvederm is more hydrophilic than other fillers).  In my experience, Belotero is the optimal performing filler for this region.  That said, many plastic surgeons like to use Juvederm.
Do you know how much "dissolvent" was used?  It may be that an additional treatment with Hyaluronidase, the treatment to dissolve Juvederm may be needed.  Sometimes several treatments are needed.
It may be that lower eyelift surgery may be what you are looking for, although I would allow the swelling to be treated and subside before having any surgery performed.
It is also my hope that your plastic surgeon is responsive to your concerns and will work with you to a satisfactory resolution.  
If you have additional question, please submit.
Jefrey Fishman, MD, FACS
Associate Professor of Surgery
     Oakland University William Beaumont School of Medicine
Chief, Section of Plastic Surgery
     St John Providence Hospital - Ascension Health System
Diplomate, American Board of Surgery
Subspecialty Certification in Hand Surgery
Diplomate, American Board of Plastic Surgery

A month after steroids and dissolver there's no change in my under eye bags. How do I get rid of them after Juvéderm? (photo)

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