Under eye bag effect due to Juvederm Voluma. What to do now? (Photo)

Volumetric fillers are volume dependent and need to be precisely injected in the correct volume to achieve the desired effect. Additional filler in the upper cheek region can help volumize this area which can smooth lines and treat malar creases. Juvederm could be injected for additional correction of the tear trough. Bagginess after injections could be residual edema or product injected too superficial or not enough lateral malar volume. After adequate volume correction, skin care and/or resurfacing combined with neuromodualtors could help smooth this region.

You may need more filler or hyaluronidase injected there. It will depend on your exam. Voluma is usually not injected that close to the eye- however, there are exceptions. The hyaluronidase may require more than one injection to get it to the point where the Voluma is reduced sufficiently. 

Thank you for submitting your question. Voluma is not Injected into the lower eyelid.  If there was an injection then hyaluronidase will reverse. Do not inject any more voluma into that area.  Consult with a board certified experienced injector.  Best Wishes

When volume is added in
the cheeks, right under the eyes, wrinkles can be caused when the person
smiles. Either dissolve some of the product or start Pelleve treatments
to address the wrinkling.

Thank you for your very valid question.This can occur frequently in practice and can be due to one of three things. It is hard to determine which of the three caused it in your situation without fully examining your eyelid and lid-cheek junction and also obtaining history about your age, eating and drinking habits and your pre-existing body chemistry. The pictures do not show enough of your eyelid and cheek to make that determination. It could be that your treatment is not complete yet and that you need an eyelid filler to fill the eyelid dent and smooth out the lid to cheek junction. It could be that you had some lax eyelid skin that welcomed the resultant swelling from the adjacent Voluma injection. (In my practice I always tighten even mildly  lax eyelid skin with non-invasive technology  first before injecting at or near the eyelids - this can still be done for you to make the bag go down,  but it has to be done by someone who is very experienced with using technology to address these issues - many people form other practitioners come to our practice for this). It is not clear from the photos if hyaluronidase will help you and that needs to be determined on examination in person......  because there is a chance that after using hyaluronidase, you might have excess loose skin in the area, so it might be better to just tighten it first.I hope these insights are helpful. Definitely seek out expert and experienced care by a Board Certified Facial Plastic / Plastic surgeon, well versed in injectibles and non-invasive technologies.  Si vous voulez parler en Francais, ca va. On ne doit pas aller a Paris pour ca !Bon Chance !Dr. Anna Petropoulos, Boston.

Thank you for your question and picture, and I see your area of concern.  This area is where eye bags do develop with time and age, but if you are confident that this eye bag was created after the Voluma was placed, it would be best to reverse the filler placement with hyaluronidase.  As you would need this administered by a physician, it would be best to voice your concerns to them so that they can examine your eye area and offer the best treatment.  

Voluma is indicated for midface volume restoration. It has a high "gel hardness" which makes it appropriate for areas where lift is desired. Under the eyes, if you have had a problem with Voluma, you may want a filler that is soft and spreads more easily, like Beletero or Restylane.  In the meantime, a little hyaluronidase should flatten your new eye bag. 

I am sure there are many qualified physicians in NY that can help you.  It may need hyaluronidase .  However,  I would recommend that you have someone evaluate it that has experience with fillers.  Massage or a small injection with numbing and an 11 blase may force out a small amount of material. Be sure that they have Hyaluronidase in the office before you make the appointment but there may be other less invasive ways to manage this.

I prefer a combination of Voluma and Juvederm. The Voluma is used to enhance the cheek bones and the Juvederm is used for minor corrections just like what you are describing. I would ask your surgeon his/her opinion and possibly use some Juvederm for this issue that has come up.

It is a little difficult to tell for certain from your close cropped photo.  However, I suspect that the Voluma was injected a little too deep for that area.  There is a tissue called the septum under the skin and muscle of the eyelid. Generally fillers should not be placed behind the septum (there are some rare exceptions)  On the cheek, it is a good thing to inject the Voluma a deep as possible.  However in the eyelid the Voluma can not be placed that deep or it will cause a worsening of the bag.  Voluma lasts a long time, probably years in that area.  I would suggest having the Voluma dissolved with hyaluronidase which should restore everything back to the way it was prior to the treatment. Hope this is helpful.