Fillers - which one and where to inject to remove under eye circles and expression lines?

I had Juvaderm injected under my eyes and in my expression lines in December. It looks like the Juvaderm placed under my eyes migrated down to look like small marbles underneath the skin about an inch below my tear duct. I went to see another surgeon last month and she strongly advised against injecting directly into the lines and injecting in the cheek to cause a lift, which she said would eliminate both problem areas. Help! What should I do? Thank you:)

Doctor Answers 9

What to inject into the tear troughs

Thank you for sharing your question. Juvederm causes excessive swelling and potentially blue discoloration of skin in the tear troughs. Resylane is probably the best filler for the tear troughs. Discuss dissolving the Juvederm with your doctor and reinjection with Restylane. Make sure injections are performed by an experienced doctor.
Good luck,

Tear troughs

Hello, and thanks for your question. I'm sorry you did not get the result you had hoped for. 

Juvederm is not my favorite product for tear troughs. You could consider have it dissolved and trying a softer product like Belotero Balance or Restylane Silk. To maximize the likelihood of a favorable outcome, I recommend that you only get treated by a well-trained and experienced dermatologist or plastic surgeon. Hope this opinion is helpful to you.

Best of luck, Dr. Frucht.   

Corey Frucht, MD, PhD
Santa Barbara Dermatologic Surgeon
5.0 out of 5 stars 4 reviews

Poor results from fillers under eyes

I am sorry to hear about your problems.  Juvederm is generally a poor choice for use in the tear trough region.  It may or may not need to be removed with hyaluronidase.  Other fillers can be used with success in this area.  Placing filler superficially to treat lines is tricky and should only be attempted by extremely experienced injectors.  I recommend seeing a highly experienced injector to make a plan for what steps you can take to achieve best outcomes.   

Brian Biesman, MD
Nashville Oculoplastic Surgeon
4.8 out of 5 stars 41 reviews

Dark Circles, Eyelid Wrinkles/Bags Treatment -- Restylane or Belotero with Cannulas, Clear+Brilliant, Eclipse Micropen, Viva

if you unhappy with your results, you can reverse the fillers with an enzyme hyaluroniase. I suggest seeing an expert.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.9 out of 5 stars 165 reviews

Restylane under the eyes

I prefer Restylane under the eyes.  It does not swell as much as Juvederm and has a good lifting capacity.  Proper injection technique is important in this area.  I typically will use a cannula instead of a needle.  A cannula has a blunt tip and has a much lower risk of bruising or other problems.  Occasionally I will use a needle to fine tune the results but most of the time I only use a cannula in this area.
Regards,
Dr. Ort

Richard Ort, MD
Lone Tree Dermatologic Surgeon
5.0 out of 5 stars 22 reviews

Juvederm in tear trough

Juvederm is not the best filler for under the eyes as it can cause swelling and occasionally lumps.  You will need to get the filler dissolved.  Adding some filler to the cheeks can help with the lower lid decreasing the need for filler directly into the tear trough.   

John J. Martin, Jr., MD
Coral Gables Oculoplastic Surgeon
5.0 out of 5 stars 25 reviews

Fillers - which one and where to inject to remove under eye circles and expression lines?

Thank you for your question and I can understand your confusion.  Oftentimes there is not a single filler material that works best to address all of a patient's needs and a series of treatments may be needed to achieve your desired results.  Without photographs to make definite recommendations, some filler placement into the cheeks, such as Voluma, can help improve a patient's smile lines as well as lend support to the lower eyelid to improve its appearance.  This tends to minimize the appearance of these two regions but often times fine tuning of the results with additional Juvederm to the perioral lines and lower eyelid, or restylane to the lower eyelid is needed.  Hope this helps and be sure to see a board certified plastic surgeon in consultation. 

Nelson Castillo, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 43 reviews

Under Eye Fillers

It sounds like you will need to have Vitrase dissolve the filler that left these lumps.  I would consider having Belotero into the eye area or Voluma injected into the cheeks to lift this area.  Please consult an expert.  Best, Dr. Green

Filler to improve under eye circles

Hello Christilee,

Juvederm can be useful to improve under eye circles but should be injected at a deep level just above the bone or the filler can collect and be visible like you are describing.  I have found that using products like Restylane Lyft or Voluma injected onto the bone to elevate the cheek area does a beautiful job of diminishing the under eye circles without directly injecting under them.  The cheek lift helps correct  the difference in elevation from the tissue of the lower eyelid to the cheek junction which is largely responsible for the appearance of the under eye circles.  

If the lines you are hoping to eliminate are due to expression, Botox will be the most effective treatment as it is indicated for dynamic lines and treating the source of the lines.  Static lines (those present without active expression) can be effectively treated with a number of different types of fillers depending on their depth and location.  

I would recommend making sure you go to an experienced injector who is familiar with multiple types of fillers as well as Botox who can offer you the most effective treatment for your concern areas without the worry of having a poor result.

Best of Luck!

Dr. Rednam

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.