Belafill injections under eyes gone wrong!

Hi and thank you for your question! To avoid lumps and other issues under the eyes, the fillers of choice for this area typically include Restylane Silk, Volbella or Belotero. With Bellafill injection in this area, at times waiting out might helps with reducing the lumps. I personally don't think Ultherapy could help in breaking the lumps down, but as a non-invasive treatment you might stand little harm to try it out. Nonetheless, there is a possibility that Ultherapy results in additional volume loss in under the eyes, worsening the appearance of the lumps. Other options include careful mechanical breaking down and use of steroid injection. Careful injection of appropriate hyaluronic acid fillers can also help with concealing the problem. All in all, it's best to consult a highly experienced cosmetic doctor with experience in injections under the eyes to fully evaluate and discuss the options. I hope it helps and good luck!  

We are specialists in the removal of Artefill from the face and body. Inflammatory mediators can wreak havoc on permanent fillers, causing swelling and pain. Early removal is key. I would use SwellX to reduce swelling, if possible. Best, Dr. KaramanoukianLos Angeles

Thank you for sharing your question.  You are right in that there is no antidote or reversal agent for Bellafill.  Improvement in the lumps may be possible with either a steroid injection using Kenalog, or the lumps would need to be surgically removed.  See your injector for an in-person examination and discussion.

I'm sorry to hear about your experience with Bellafill. There may be a bit of scar tissue formation around the product injected, this is rare but can happen.  A few treatments of Kenalog 10mg/ml combined with 5FU should improve the lumps over time. Perhaps Xiaflex (collagenase) may be an option as well if the Kenalog combo doesn't help. Bellafill is a great product and its unfortunate that you are experiencing this. 

Hello there Kristie,I'm sorry to hear about your situation.  Bellafill is not a great product to inject in the tear trough area for many reasons.  Unfortunately, since it is not dissolvable, the only way to really remove it would be with removing it surgically.  Ulthera and other products such as Kenalog will produce only minimal results and if the lumps are visible, those treatments will not cause enough change for you to be satisfied.  The best recommendation I can give is to have a lower blepharoplasty so the surgeon can go in and correctly remove the product.  Hope this helps.All the best,Carlos Mata, MD, MBA, FACSBoard-Certified Plastic Surgeon

I believe that Bellafill is actually contraindicated for treatment of the tear trough area, exactly because of the kind of complication you are describing.  If it is performed by a physician experienced in using Bellafill in the tear trough, the filler must be placed beneath the orbiculares muscle.  Even so, I believe volbella or belotero, or even diluted restylane, are far safer choices for treatment of the tear troughs.However, I have, over the years, seen a number of patients with the problems you describe.  My algorithm for treating the hard lumps that form in the tear troughs after treatment with bellafill follows an ascending ladder of intervention. One tactic is to try to camouflage the lumps by injecting another filler, such as the ones I mentioned previously, at a more superficial level, although it is possible that in this case, the bellafill is already so superficial that there is no room to place filler more superficially.The next level of intervention is to inject small boluses of kenalog, hyaluronidase, and 5 FU, all of which can cause some shrinkage in the size of these lumps in the tear trough area.  I personally have had some success in pairing these injections with Ultherapy of the the tear troughs.  Finally, if sufficient correction cannot be obtained with any of these modalities, surgical excision via a lower blepharoplasty incision is the ultimate course of treatment, although the surgeon must be careful to try avoid resultant contour irregulars of the skin that may occur following this procedure.

The hard lumps you see are likely because the product was injected too superficially. Although it is an off label indication to use Bellafil for the tear through I have seen great results if done appropriately. It has to be placed with a cannula, not a needle and deep under the orbicularis muscle. The hard lumps can be injected with a very small dose of Kenalog and they should diminish since the main component of these lumps is now your own collagen that would decrease substantially with this technique. Good luck

The nodule is unlikely to go away with ultrasound and unlike hyaluronic acid fillers (Juvederm or Restylane) this filler cannot be dissolved.  The best treatment would be to have a lower eyelid blepharoplasty and remove the nodule surgically.

I am sorry to hear about your experience with Bellafill in the area under the eyes. The skin in this area is quite thin and while Bellafill is a collagen stimulator, I avoid injecting this product under the eyes because it is difficult to correct should a problem arise. Treatment with Ultherapy is not going to correct the problem. I would begin with small injections of Kenalog or Kenalog + 5FU. With the skin being thin in this area, you may experience some bruising. The other option is surgical removal. I hope this was helpful - Dr. Moore.

Ulthera has been used to help nodules with non approved fillers. You will probably get a mild benefit from it. 5FU and Kenalog might be the first mode of treatment for me. There have been anecdotal reports of using collagenase too.