Do I have options for under-eye dents after filler? (Photos)

Hi, Note that none of the doctors seem to want to touch this question. I will try my best to help. This does happen with lower eyelid filler injections and more frequently than we would like to admit. I have seen this problem on my fellow colleagues in their instagram photos when they are smiling really big. The dilemma is that when you aren’t smiling, you actually like the result, but when you smile, clearly the technique that the filling was performed doesn’t look like the other side. So what do we do? It’s like a new Rubik’s cube puzzle that no one has been able to solve. Since it looks good when you aren’t smiling I think that we can conclude that the amount of filler is close to being correct. One thing to consider for the injectors is that there appears to be more than one layer of muscle in that area. If too much filler is in one of the two layers, then that layer is too thick and when you smile it appears to be too much filler. When injecting lower eyelid fillers, I will show examples of what you are showing in your question to my patients as one of the outcomes that sometimes happens. However, if we consider that the current injection techniques may not be perfect, then there may be a second layer under the prior layer which may benefit from some of filler from the superficial layer. If both layers have 50% it will look different from the deeper layer having 0% and the superficial layer (outer layer) having all 100%. When we inject using one layer, if the deeper layer didn’t lose much volume and kept 50% in the deeper layer, then simply filling out the superficial layer with the remaining 50% doesn’t create the problem that you are having. Based on my experience, 50-70% of patients don’t have this problem. However, the remaining may get a hint of this problem, and I may need to under fill them to prevent this from happening. and other solution option is to try to fill the dent below the bulge after it has been partially reduced. Lastly, I need to comment on dissolving Voluma. This can be a difficult proposition. It can take multiple dissolving sessions to successfully dissolve Voluma. For this reason, I don’t like to use Voluma for lower eyelid filling. Voluma can last a very long time, because it has a property called isovolumic degradation. As it actually is dissolving, the remaining broken down particles seem to take up more volume which makes it appear that it isn’t actually dissolving. Eventually when the Voluma is broken down enough it finally goes away, but not without a lot of frustration for the patient as well as for the doctor/injector. Restylane for the lower eyelid filling can already last many years and is easy to dissolve. So for that reason, I avoid Voluma. Ask your injector to dissolve the Voluma, so you can start over. If you return to your original injector, they may either dissolve the Voluma at no charge or at least at a discount relative to performing dissolving on another injector’s patient which will likely be full price. Hope this provides some value to you. Good luck. Best, Dr. Yang

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.

Yes I see the depression below your tear trough. I was wondering if the injector first supported the midface before proceeding with tear trough filler? It's very rare that I will only inject tear troughs because the midface is what supports the tear trough. Completing the midface first, and then proceeding with tear trough filler will achieve a much more balanced and natural appearance.

Based on the photos one year post treatment with voluma without having your prior treatment photos the possibilities are filler migration, superficial placement of the filler, asymmetry in correction, natural process of filler degradation. Under eye filler require in depth knowledge of anatomy, and special skills in injection. Juvederm Volbella received recent FDA approval for under eye treatment. Reviewing the photos shows also some volume loss in the mid face. Adding Vycross filler such as Voluma in the Zygoma( cheek) will elevate portion of the tear trough depending on how it is injected, thereby improving the appearance of the line. In addition it is important to have an in person evaluation by your injector to feel the area showing on the photo and determine whether if there is filler migration requiring dissolution appropriately. I recommend to have an in person consultation with a skilled physician injector.Thank you for your question, and best of luck.

You are very fortunate that you found an injector who understands the under eye and how to inject it. The residual dents, from the pictures, appear to be areas that could use a little more filler. I would discuss it with your injector.