What is the best filler for avoiding getting the tyndall effect under my eyes?

I had Juvederm ultra 3 and volbella injected under eyes. last injection was six months ago. This has given me the tyndall effect. 1) Does vitrase really "erase" the tyndall effect immediately? Have doctors actually seen that vitrase treats tyndall effect? How many times has it been successful in your experience? Should I just wait this out? 2) whether i wait for the Juvederm to dissolve or have vitrase, i'll need more filler. Belotero as an option? does it cause more swelling and tyndall?

Doctor Answers 25

Belotero Works Well For Under Eye Rejuvenation With Little Possibility of the Tyndall Effect

Although Juvederm UltraXC and Restylane L work well for treating the delicate under eye region, my personal preference in my Upper East Side Manhattan office is Belotero Balance, which is not associated with the development of the Tyndall effect--even when injected superficially. Volbella, which I use in Israel practice, where it is approved (it is not approved in the U.S. ) is marketed for use in the lips and for the peri-oral regions, rather than under the eyes. Likewise I would not have chosen Juvederm Ultra 3 (another product not available in the U.S., but available in Israel) for the infraorbital region.

Since filler treatment results under the eyes may last far longer than the usual 8-14 months that they do in other areas, it would seem prudent to dissolve the hyaluronic acid currently present and then to retreat.

New York Dermatologic Surgeon
4.9 out of 5 stars 29 reviews

Reducing blue discoloration under the eyes

if you notice a blue discoloration after an injectable, it is because the hyaluronic acid filler is a clear gel and can give a blue hue when the light hits the thin skin under the eyes.  The thinner hyaluronic acids such as Restylane and Belotero typically cause less Tyndall effect than others.  However, if too much filler is placed, it can be dissolved with hyaluronidase in 24 hours after the hyaluronidase is used.  Check with your Dermatologic Surgeon to see what treatment is right for you.

Carolyn Jacob, MD
Chicago Dermatologic Surgeon
5.0 out of 5 stars 5 reviews

Fillers to lower lids and Tyndall effect

I prefer using Restylane or Belotero when filling the lower lid/cheek area.  They have decreased incidence of swelling. Tyndell effect can be seen with various fillers including Juvederm and Restylane; Belotero is not known to cause a Tyndell effect.  It would be worthwhile for you to see an experienced injector to determine if what you see is a Tyndell effect and whether hyaluronidase will help. Hyaluronidase (aka Vitrase, Wydase) enzyme breaks down hyaluronic acid (which is what Juvederm, Restylane, and Belotero are composed of). 
Once the the product is removed, your injector can determine if you are a candidate for fillers and which one would be the best fit for you. Good luck...

Christopher I. Zoumalan, MD, FACS
Beverly Hills Oculoplastic Surgeon
5.0 out of 5 stars 102 reviews

Avoiding Tyndall

The Tyndall effect stems from the presence of hyaluronic acid in your tear-trough area. It is hard to comment on whether the filler was placed too superficially, or  was simply overinjected in terms of its volume.  Once it is dissolved with vitrase, the tyndall effect should be gone, albeit not immediately (for the injection with vitrase will need about a week or two to settle, not because it does not work right away, but because the needle entry into the delicate under-eye skin may contribute to a subtle temporary bruise).

Though Belotero Balance is a good alternative for the tear trough area, my personal favorite is Restylane.  In patients with very thin skin, or hint of under-eye circles, I tint it with a microdroplet of Radiesse.  The milky white color of Radiesse, when admixed with Restylane, helps patients with some under-eye discoloration.

Hope this helps and good luck

Tatiana Khrom, MD
New York Dermatologic Surgeon
5.0 out of 5 stars 6 reviews

Tyndall Effect and Fillers

As your injections were performed six months ago do not recommend injection of hyaluronidase at this time.  Rather would treat your issue with serial observation and see if it improves further.  Do not recommend additional filler placement until this "Tyndall Effect" improves to your satisfaction. 
Once it improves can consider further treatment.

Paul Carniol, MD
Summit Facial Plastic Surgeon
5.0 out of 5 stars 7 reviews

Filler under the eyes for dark circles should mostly be placed deep, just above the bone

Each physician has their personal preferences for which filler they use under the eyes. I prefer Restyane and Belotero. I find that the initial swelling is more intense, but after the first two days, that's it. I have found that with Juvederm, sometimes swelling can occur on and off over a few months' time.
To treat the Tyndall effect or over-filling, Vytrase is very effective. Regarding timing, dissolve the excess filler. Wait a few weeks then follow up with treatment using Restylane or Belotero.

Steven J. Pearlman, MD
New York Facial Plastic Surgeon
4.9 out of 5 stars 125 reviews

Tyndall effect after Juvaderm

Vitrase will absolutely help. Sometimes tyndall can last years - long after the Juvaderm is gone.  Seek an expert injector to discuss your options for fillers in this complicated area.

Matthew Schulman, MD
New York Plastic Surgeon
4.9 out of 5 stars 324 reviews

What is the best filler for avoiding getting the tyndall effect under my eyes?

You should seek the right injector of the right product.
This can occur with any filler and has to do with the level it is placed.
Vitrase can reverse the effect.
Best of Luck,
Dr. Malouf

Peter Malouf, DO
Dallas Dermatologist
4.7 out of 5 stars 87 reviews

Tyndall effect in tear trough

The vitrase should dissolve the juvederm and this will eliminate the blue discoloration.  Belotero is a good filler for this area specifically because it does not produce a tyndall effect.

John J. Martin, Jr., MD
Coral Gables Oculoplastic Surgeon
5.0 out of 5 stars 27 reviews

Tyndall Effect under eyes with filler

Tyndall effect is caused by excess hyaluronic acid product placed too superficially in the skin.  These fillers and the Tyndall effect they can cause may be reversed with Vitrase enzyme.  It is best to inject deep in tear trough.  I find that some injectors will inject too shallow in their attempt to correct fine under eye wrinkles.  I have corrected many a Tyndall effect from others and believe it is best to treat these shallow wrinkles with laser and use filler deeper to correct the hollows or grooves.

Hyaluronic acid fillers are still preferred in delicate areas like the tear trough because they are reversible with Vitrase.  I have used most of these fillers (Restylane, Perlane, Juvederm, even new Voluma) in this location and prefer Perlane or Juvederm.  

Good Luck!

Karen Stolman, MD
Sandy Dermatologic Surgeon
5.0 out of 5 stars 7 reviews

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.