Malar bag or festoon after Versa using cannula. Is there any way to fix this? (Photo)

Question

I had versa cheek and tear trough filler over two months ago using a cannula. I developed a festoon or malar bag under my left eye immediately after. There's a noticeable line that is present under most lighting conditions. I had some dissolved; however, it's still present. Is there anyway to fix this? Thank you in advance!!

Dallas Buchanan, MD · Answer

Thank you for your pictures and questions. HA filler in this area can be very tricky and it is easy to cause some unintended outcomes. Sometimes product in this area can disrupt the lymphatics and cause worsening of the malar edema. My best advice is to have the product completely dissolved and this may require multiple sessions of injection with hyaluronidase. If there is question as to whether additional product is still present, an ultrasound of the area by your practitioner may be helpful.

Best of luck!

Dallas Buchanan, MD
VIVIFY plastic surgery
Tampa, FL

Best of luck!

Dallas Buchanan, MD
VIVIFY plastic surgery
Tampa, FL

Nima Shemirani, MD · Answer

Hi @christi2081! I would try a radiofrequency microneedling device like Morpheus 8. Morpheus8 is a non-surgical treatment for full body skin resurfacing, skin tightening, and fat reduction of stubborn areas. It uses minimally invasive fractional radiofrequency energy (RF) to penetrate the skin deeper than other microneedling devices, triggering the skin’s natural healing response to promote skin tightening and lifting. Best of luck, Dr. Nima!

Raffy Karamanoukian, MD, FACS · Answer

Filler migration, swelling, and granulomas can cause significant discomfort and cosmetic ramifications. Our office specializes in the use of enzymes and filler reversal techniques without hyaluronidase to help improve the results of botched cosmetic fillers, whether caused by Juvederm, Restylane, or foreign fillers. Our plastic surgery institute provides expertise in filler removal. We begin by examining the facial fillers and assessing the likelihood of fluctuance or liquid volumization. If appropriate, we use Hylenex, or other filler reversal agents to reduce swelling and filler migration. Hylenex can be targeted into the areas of concern using multiple layered injection techniques. If the filler does not completely resolve, then additional concentrations may be employed. The technique has the potential to reduce the filler and may slightly impact normal hyaluronic acid. Treatments are repeated and results can improve immediately and with time.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Darryl J. Blinski, MD · Answer

Best is ONLY in person examination. I might offer micro droplets of Juvederm VolBella in a few sessions along with hyper diluted KyBella in malar areas. Fees per session $1,000.

Robert T. Buchanan, MD (retired) · Answer

You bring up one of the common misunderstandings about the molar area. Versa is supposed to absorb less water than "other" fillers, which is why some injectors use it in the molar area. However, Juvederm Volbella and Vollure also absorb almost no water, but they are not appropriate for the under eye area. It is not the water the filler absorbs that is the problem. It is where it is injected that is the problem. The vast majority of injectors inject above the orbital ligament superficially. This blocks the body's lymphatics preventing normal drainage of the area and, thus, causing the swelling. Proper injection technique is to use a heavy filler like Radiesse or Juvederm Voluma below the ligament on the bone or muscle attachment. See a true expert in the area who uses the above technique.

Malar bag or festoon after Versa using cannula. Is there any way to fix this? (Photo)

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