Under eye area looks terrible and filler not working - what are my opinions? (photos)

Question

I am very distressed and depressed about how my under-eye area looks. I am 52 years old. I have had past problems with juvederm being injected under my eyes and had it dissolved using hyaluronidase about 4 years ago. The doctor then added a little Belotero instead but it has never been the same. For the past 4 years, I've had Radiesse injections only in my cheeks every 2 or 3 months. I look horrible but my injector says I just need to stop consuming sodium. I feel hopeless-any advice please!

Marc Polacco, MD · Answer

Thank you for your question. Your concern is very common, and something I see on a daily basis. At this stage, it appears that filler has replaced the volume loss we experience in this region as we age. However, there is also skin laxity and fine lines which filler certainly cannot treat, and may even make more apparent in some instances. Typically I will recommend a lower blepharoplasty to address skin laxity, as well as laser resurfacing, which serves to treat fine lines and also tightens the skin. There is about a week of downtime involved in this, but based on your photos this would serve to address your concerns. All the best.

Nima Shemirani, MD · Answer

Hi @rayoflight25! I would recommend dissolving the filler with Hylenex following by a lower blepharoplasty. Best of luck, Dr. Nima!

Mehryar (Ray) Taban, MD, FACS · Answer

You likely need the filler dissolved and then do lower blepharoplasty (as detailed in attached publication) but best to have personal evaluation to determine.

Zoran Potparic, MD · Answer

Based on these photos, you seem to be good candidate for lower blepharoplasty and chemical, TCA peel of lower eyelids, possibly periorbital fat, micro and nano grafts.. In person consultation with a board certified plastic surgeon with good reputation in eyelid surgery is recommended. Good luck.

Lawrence Kass, MD · Answer

There is little doubt that with the right care by the right physician you might benefit from considerable improvement in this area.  I agree with some comments by others.  Certainly, I would avoid ALL fillers to lower eyelids and cheeks.  Just stop.  It's making everything worse.  I would definitely not seek further treatment from your current injector.  I would trust any additional treatment only to a fully trained and experienced oculofacial plastic surgeon.  While I agree that you might consider further enzyme treatment  to the area, I believe that you will likely require surgery for any hope of improvement.  These are festoons.  The treatment of festoons is intricate and complex.  Ask to see photos of others who the doctor has treated whose eyelids look similar to yours.  Good luck!

Fernando Colon, MD · Answer

You need a detailed evaluation with an oculoplastic surgeon. I would
not recommend anymore fillers in this area.

Kenneth D. Steinsapir, MD · Answer

Radiesse can not be removed. It is an absurd filler product in my opinion. It is said to break down over time. However it is a calcium product and I am skeptical about how much does disappear over time. Unlike hyaluronic acid fillers, there is no simple method to erase over done product. Stop getting Radiesse. This product is not helping you. Stop going to the injector who is providing this service. Regarding the Belotero and the other runny products injected into you lower eyelid area, these are also terrible products for this location. You may have had some enzyme in the past, however, your photographs make clear that you still have plenty of funky, runny hyaluronic filler in your lower eyelid. This can be cleared with hyalruonidase, the enzyme that brakes down hyaluronic acid. However you need the correct does to deplete this material. That is not a squirt of enzyme. Likely these products affecting the lower eyelid also inhabit the cheek as well do to their tendency to be runny. Belotero is so runny that it does not even form the Tyndall effect. There is help for you but you need to see the right provider.

Richard Wellington Swift, MD · Answer

Thank you for posting your interesting question. I would recommend a lower transconjuctival blepharoplasty with a skin pinch to remove the puffiness and smooth the lower eyelid lines. I recommend that you have a consultation with a Board Certified Plastic Surgeon who is experienced with blepharoplasty. Best wishes, Richard Wellington Swift, M.D., F.A.C.S.

Robert Singer, MD · Answer

Most expert experienced artistic plastic surgeons have a variety of procedures, both non-surgical and surgical, at their disposal to produce excellent cosmetic results in the appropriately selected patient: temporary fillers, micro-fat grafts, and blepharoplasties.  Each has benefits and drawbacks and depends on desired outcome and individual anatomy.

In a patient with your inherited anatomy, a blepharoplasty will produce the best and longest lasting cosmetic result.

Following the advice of anyone who would presume to tell you what to do without seeing photos and without taking a full medical history, examining you, feeling and assessing your tissue tone, discussing your desired outcome and fully informing you about the pros and cons of each option would not be in your best interest. Find a plastic surgeon that you are comfortable with and one that you trust and listen to his or her advice. The surgeon should be certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS). You should discuss your concerns with that surgeon in person.

Robert Singer, MD FACS

La Jolla, California

Darryl J. Blinski, MD · Answer

In your case ONLY in person detailed examination would allow a determination of the factors and dx involved. I might consider lower lid blepharoplasty with nano fat grafting.

Under eye area looks terrible and filler not working - what are my opinions? (photos)

Answers (12)

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