Should I try Filler Under the Eyes?
Hi PE. There are two issues we see related to "wrinkles under the eyes". There appears to be what another physician described as the banana role (directly under the eyes in photo 3). This is the very thin skin immediately under the eyes that you have when smiling very large. This area is typically difficult to remedy with fillers.
If you said that you were only concerned about the small roll directly under the eye, we probably would recommend leaving this. It's difficult to fix because it only appears when smiling. If there is more loose skin in the future, then a lower blepharoplasty (eye surgery) may help with this, but not now in your current situation.
The other "line" is the naso-jugal groove that runs from the inner corner of the eye and down toward the cheek. This is apparent in photos 2 and 5.
The naso-jugal groove in photos 2 and 5 s an area where the tear trough injection procedure should have helped. It appears that in photo 4 most of the product was placed very close to the nose and inner corner of the eye instead of the area in the middle or even outer (and lower) eye. This appears to have made the inner eye puffy.
A different injection technique may be able to accomplish what you want in this area, but your feedback on what you didn't like about the previous injection would be integral to providing an acceptable and alternative solution.
To see examples of before and after patients in Los Angeles that have had tear trough injections, click on the link below.
Under eye wrinkles
I see that when you smile you have a "banana roll" as well as some fine lines under your eyes. When not smiling you have a prominent tear trough groove and some darkness or undereye shadow. Most of your pictures with filler show you smiling which makes it difficult to see how the filler changed or didn't change your prominent tear trough groove. I assume the filler was placed in your upper cheek and possibly tear trough. Now that the filler is out, I would suggest a little Botox for your undereye "banana roll". Filler placed in a smaller quantity with sharp skill could have lessened your tear trough well. Though, filler in the tear trough can result in swelling for as long as four weeks, and the need for microadjusting too. Skin laxity and thinning from age and sun damage, as well as genetics contribute to your undereye problems. Filler not only physical replaces what may be missing but can stimulate new collagen formation resulting in healthier, younger looking skin. Another approach, other than filler, would be to strengthen and thicken the skin with laser resurfacing or radiofrequency (RF) tightening (Invasix Firm, or Endymed). For severe case, I do both filler and laser or RF tightening.
Dear patient, my suggestion is for you to wait for the filler to slowly dissipate. This may take 6 months or longer. I know this difficult to do; but it is always easier to start with a clen slate.Consider using a device to tighten the skin rather than to fill the hollowness. Look into Ultherapy.
Wrinkles under eyes
Without good clinical pictures, it is very difficult to assess the problem adequately. The roll under the yes with active smiling is likely due to hyperactive orbicular is muscle which should respond well to 1-2 units of Botox injected immediately under the skin in the mid portion 2 mm below the lower lash. Otherwise, it looks like you have a "tear trough" deformity which should respond to HA filler injection in the deep or supra-periosteal plane. This is tricky and if not done by an experienced injector, will cause a worse deformity. The correction will be most notice at rest. With maximum facial mimetic muscle contraction, all bets are off. We try to correct what we see in repose not in dynamic movement. Also, I prefer HA fillers (i.e. Juvederm, Restylane) rather than CHA (Radiesse) because you can diminish or dissolve HA, you can't do anything to CHA if its improperly placed.