How is Juvederm Injected Best for Under the Eyes?

Question

Is Juvederm best injected deeply or just under the surface of the skin for the hollows under the eyes/tear trough area?  Is one less likely to created a baggy look? Is a numbing cream sufficient for painless injections or are numbing injections necessary too? I'm trying to locate a doctor in Orange County who won't create under eye bags but with a minimal amount of pain.

Harold J. Kaplan, MD · Answer

Any hyaluronic acid dermal filler injected in the "tear trough" area under the eyes should be injected under the muscle (deeply) to avoid lumpiness at the surface of the skin.  As mentioned, good results in this area is very technique dependent.  Numbing cream is sufficient for this treatment.
Our office is located in the city of Orange, right behind Children's Hospital and we would be happy to see you for a free consultation regarding the procedure.  Visit our website link below for before and after pictures of this procedure.  As an aside, we use Restylane in this area and not Juvederm.

Richard J. Bruneteau, MD · Answer

Juvederm is a hyaluronic acid dermal filler that’s
associated with excellent clinical results and high patient satisfaction
rates. It’s easily injected and has a
smooth soft presentation. Juvederm is very
versatile and can be used in multiple anatomic locations. When the eyelids are treated it’s important
to be cautious for several reasons. In
this area the anatomy is very complex and the skin is very thin.Superficial
injections can be associated with several problems. These include lumps and bumps which are
accompanied by a bluish discoloration of the skin. In some cases, there may be a diffuse bulge
in the area of the lower eyelids from expansion of loose lower eyelid skin. Superficial injections in this area are often
painful despite topical anesthesia which is usually effective. For these reasons, deeper injections are
often more effective then superficial injections. These injections should be placed beneath the
muscles and small volumes should be utilized. It’s
important that these issues be discussed with your physician before proceeding
with Juvederm eyelid injections. Your
physician should be able to explain his or her approach and alleviate your
anxiety.

Rian A. Maercks, MD · Answer

I prefer to use an infraorbital block so that my patients feel nothing and that way I am  able to inject in multiple planes depending on patient needs.  I dont think a great result can be achieved without doing this.

	 

	All the best,

	 

	Rian A. Maercks M.D.

Dmitriy Schwarzburg, MD · Answer

There are several things to learn and consider in the administration of fillers. Doctors take years of training and experience to figure these out. Please contact a qualified provider or a board-certified physician with extensive experience in these procedures.

Michele S. Green, MD · Answer

Juvederm is a great facial filler but not best filler for the delicate area under the eyes.  I bring patients into the office and numb the area with a topical numbing cream for one hour before the injection.  I utilize either Belotero or Resytlane for the fine under eye area.  The procedure is painless but usually causes some temporary bruising.  Please consult a board certified dermatologist with a great deal of experience with this cosmetic injection for the best results.

Peter A. Aldea, MD · Answer

Although we may disagree on several technical points, I think most Plastic surgeons would inject the Restylane deep, on the bone along the rim of the orbit. Injecting it superficially may be associated with swelling and a blue tinge (Tyndall effect).
As regards anesthesia, I prefer to block the nerve supplying feeling to the cheeks - which totally numbs the lower lid as well. As a result, my patients feel NO PAIN when having such treatments.
Dr. P. Aldea

Dan Mills, MD · Answer

If you inject the eyes just under the skin around the eyes, it is much more likely to be lumpy than if you inject right on top of the bone. It also hurts much more superficially. My PAs are not allowed to inject there, only me. This is because I feel that it is really good to have done the surgery, and to know the anatomy very well in this area before injecting - another reason that a Board Certified Plastic Surgeon, and a member of the American Society for Aesthetic Surgery, should be your choice to see you. Look carefully at credentials before you go in.

Stella Desyatnikova, MD · Answer

Juvederm and Restylane both work great to improve the appearance of hollow tear trough area. These injections are extremely technique dependent. I usually inject small amounts at different levels, some deep, some more superficial. We don't do a lot of massaging. The product has to be injected well to avoid lumpiness. If it is, no massaging is necessary. Topical numbing cream works very well in these areas, so the procedure is very well tolerated.

Steven Wallach, MD · Answer

Juvederm is used off-label in this area.
If I am treating fine lines, then I will very gently and in small amounts inject it underneath the skin and then massage it in so it does not create lumps.  If it is for tear trough areas then I will inject it deeper and massage it in as well.
I find topical creams work very well if you allow them to work (30-40 minutes).  I inform my patients that if they notice lumps after the swelling goes down, then they can massage it for a day or two to flatten it out.

Francis R. Palmer, III, MD (retired) · Answer

IMHO, it's best to inject the Juvederm deeply within the lower eyelid area, just adjacent to the bone. This avoids the numerous small vessels within the tissue and decreases to lumpy effect of the injected Juvederm.

How is Juvederm Injected Best for Under the Eyes?

Answers (13)