I look like I have "bags" under my eyes after Bellafill injection? (Photo)

Question

I was wondering if this is normal to have what looks like bags under my eyes after Bellafill injection. I had it done last week. It is not hard lumps. I feel like I look worse than before I had injection. I only had one syringe put in and only under my eyes. I am disappointed so far.

Jason Emer, MD · Answer

For unique cases where a variety of modalities could be used to treat the condition, I would suggest an in person or virtual consultation to develop a custom and effective treatment plan.  It is difficult to precisely define the best option without collecting the same information. I suggest reaching out to an expert for a consultation with surgical and non-surgical methods to get a comprehensive option. Best, Dr. Emer.

Raffy Karamanoukian, MD, FACS · Answer

Bellafill filler can cause nodules and chronic edema, soft tissue reaction, and longterm problems. We specialize in the removal of Bellafill on the face and see patients with old and new PMMA filler problems. Bellafill will eventually form scar tissue around the permanent filler. We recommend a combination approach of filler reversal with enzymes, corticosteroids, and scar tissue modulators. Our HIDEF approach can break down filler scarring and granulomas so that they are less apparent. If the filler material itself does not dissolve, it either means the filler is unresponsive to conservative therapy. This technique may be followed by surgical removal of the filler if there is a suitable target for removal and the chance of scarring is low. We remove Bellafill filler from the lips, nasolabial folds, and eyelids. Cheek Bellafill is difficult to remove surgically.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Steven F. Weiner, MD · Answer

Swelling from filler (any filler) can persist for 10-14 days in this area, particularly with patients with malar bags/festoons. A course of steroids might be helpful. Care must be done when injecting patients with these because there is a risk of these becoming more prominent. You periocular area needs much more volume and I would probably use HA for this so it can be reversed. I don't think your one syringe is adequate for the correction you need.

Suneel Chilukuri, MD · Answer

Thank you for sharing your photos and concern.  You may be experiencing swelling / edema which will cause “festooning” that is evident in the photos.  There are two common reasons for swelling after tear trough filler.  The most common reason is that your dermatologist or plastic surgeon used a hydrophilic (water-attracting) filler such as Juvederm Ultra or Ultra Plus.  The second most common reason is that a neuromodulator (Botox, Dysport, Xeomin) was injected at the same time as your filler.  As a result, your muscles are not able to properly drain the lymphatic fluid that is now collected under your eyes.  Are you sure that Bellafill and not Beletero was placed?  I hope that you are mistaken in the placement of Bellafill under the eyes / tear trough region as this is not a proper location for this product. Please return to your board certified dermatologist or plastic surgeon for further evaluation and management. Best of luck,Suneel Chilukuri, M.D.Houston, Texas

Brian Windle, MD (retired) · Answer

Bellafill is a great solution for lower lower eyelid bags and tear troughs but at a week you cannot judge your results.  There will still be swelling which can last for a month or more.  Your photo definitely shows selling as a result of the trauma from your injections.  There is also a little yellow discoloration of your skin suggesting some bruising and further trauma.  You have to be patient.  I have add a video and web reference that may help.Best regards.

Robert J. Troell, MD, FACS - Account Suspended · Answer

Good Day. Thank you for your photograph, history and question.Your photograph and timing post-injection suggest swelling and not excess filler. You do have some inelastic skin and subcutaneous edema in the medial cheek bone (malar eminence) area known as a festoon. You can add an oral steroid, such as a Medrol dose pack to speed edema recovery. However, I usually start this medication within the first 48 hours post-injection if swelling is noted. The efficacy at this point is not as monumental.Your photograph also shows that you display additional mid face volume loss to the tear trough, nasojugal groove extending to the submalar area an also the lateral cheek bone (malar area and zygoma). Additional volume will improve the mid face appearance.Volume options include more Bellafill, HLA fillers, fat transfer and a silastic implant. With the amount of volume loss, a soft silastic combined mid face implant is perhaps the best option since it is permanent, reversible, suspends the soft tissues of the face to a higher level, and yields excellent cosmetic outcomes.If the festoon is not improved satisfactory with volume replacement alone, consider RF or laser skin resurfacing If this is unsuccessful, I introduced a new technique at the last American Academy of Facial Plastic Surgery meeting that using ultrasound below the skin to tighten the festoons skin and ablate the subcutaneous space containing water.Good luck with your choices.

I look like I have "bags" under my eyes after Bellafill injection? (Photo)

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