Hylenex/steroid and EndyMed for prolonged post-lower blepharoplasty swelling - is it worth the risks? (photos)

Question

3 months post lower bleph, & still visibly swollen under one eye. The doctor -- a highly rated oculoplastic surgeon – is recommending a steroid/hylenex injection to the area to improve swelling, and a series of RF o tighten skin. I'm very nervous about hylenex as so many people report here that it's left them hollow, with less natural HA, and there's a lot of negative reviews of RF for diminishing facial fat. I’m already thin and don’t want to lose volume.

Kenneth D. Steinsapir, MD · Answer

Generally injecting hyaluronidase into areas that are holding prior hyaluronic acid filler treatment but have too much or unwanted volume is a good idea. If the issue is not caused by retailed hyaluronic acid filler, there is no harm in this approach. If the issue is caused by old hyaluronic acid filler, the enzyme will help the issue. On the other hand, injecting this area with steroids will kill cheek fat and atrophy the thin eyelid skin. Nothing good will come of the steroid injection and it has the potential to ruin your lower eyelids. That demonstrates very poor judgement. The use of Endymed or any RF treatments in this area is highly unpredictable. I would not recommend this approach. I suggest getting other opinions.

Jonathan Cabin, MD · Answer

Hi there, 
I'm sorry you're experiencing delayed swelling. This can happen from time-to-time with lower bleph, and usually resolves overtime. Hylenex is safe, but it's only necessary if you have any history of undereye filler. Even if the filler was previously dissolved and/or many years ago, there is a chance there is still some there that is causing that area to act like a "sponge". I know some people talk about permanent issues with Hylenex, but I don't think it's ever been proven and it doesn't make sense based on how it works. I personally don't like to inject steroid under the eye, given the sensitivity of the eyelid. I would highly recommend 5-fluorouracil (5FU) off-label, which works similarly but has less potential side effects and is used around the eye very frequently. Regarding RF - if used correctly it will not reduce your facial fat, and it can help with prolonged edema. However, I would only recommend it after trying hylenex/5FU injections.
Of course, the very best thing is to work with the surgeon who performed the surgery, as he/she knows most about what was specifically done. Hope this helps! Best, Dr. Cabin

Zoran Potparic, MD · Answer

Injection of corticosteroid like Kenalog and application of pressure and mild heat may help to speed up resolution of edema (swelling). Good luck.

Hylenex/steroid and EndyMed for prolonged post-lower blepharoplasty swelling - is it worth the risks? (photos)

Answers (3)