Was I a bad candidate for under eye fillers? The results were so minimal. (Photos)

Question

On 2/28/18 I had 1 syringe to each tear trough area of of Restalyne Refine = 2 syringes. Also 1 syringe of Juvaderm Voluma shared between both eyes to the cheek area. It cost me $2,200. I was so upset that the results were so minimal. The clinician told me to return in 2 weeks and she would do another round of the same. So an additional $2200 for a total of $4400. Do I go back and hope it works or perhaps go an be evaluated with another provider that will tell me what my best option should be? I

Jack G. Bertolino, MD · Answer

This is certainly a good product for the eyes. It can cause much less swelling if put in the right place and done slowly. With eyes I put half the syringe in at one sitting then bring the client back and complete the treatment 1 week later. Hope this helps. JB

Jonathan Kulbersh, MD · Answer

Thank you for your question and I'm sorry you were not happy with your results. Dermal filler is a common treatment in the tear trough area because it adds the subtle volume necessary to reduce discoloration and refresh the appearance. Notice that I say reduce and not eliminate - an injectable treatment has limits in exactly how much improvement it can produce. It is critical patients have a realistic expectation for their procedure to avoid disappointment like yours. That said, my guess is that you would require lower blepharoplasty to fully rejuvenate the area, as this surgical procedure offers more dramatic results. In the meantime, you have achieved some nice improvement with the filler that you will be able to enjoy for a few months until you decide whether surgery is the right next step for you.

Jed H. Horowitz, MD, FACS · Answer

As I see your pictures, there was a small benefit to your under eye injections.  In this area, I always explain to patients that the improvement at best would be around 30 percent.  The only way to get a better result would be surgery.   This injections may at least buy you time until you decide to have surgery.

Hooman Khorasani, MD · Answer

Great question and thank you for the photos. On the first set of photos to the second there appears to be a good response but on vertical view it does appear that there still is room for improvement. I would recommend seeing a cosmetic surgeon that has extensive training in lower eyelid blepharoplasty (with transconjunctival approach) this surgeon can evaluate you to see if you are a good candidate.  All the best.

Elham Jafari, MD · Answer

Hi and thank you for your question! I am sorry to hear about your frustration but quite frankly, based on your pictures I do think that you had good results. When doing consultation with my patients, I always try my best to create right expectations so that my patients can make a well-informed decision. The keyword in cosmetic medicine is "improvement". Quite often our goal here is to achieve significant improvement compared with the baseline of the patient. While complete removal and correction of the concern for which the patient comes to see us is possible, it is not something that can be achieved in all cases and setting the expectations right is very important. After waiting for 2 weeks, I highly recommend that you do the follow up and reassessment to know where you stand and what the further options are and then you can decide. In general, even if you ended up needing more fillers for better results, I doubt that it will be as much as you had initially needed. I hope it helps and good luck!

Anil R. Shah, MD · Answer

Undereye filler is super challenging.  The goal is to add to the area and avoid a puffy appearance.  The filler should be placed at the junction between the lower lid fat and the cheek (this typically corresponds to the orbital bone).  In your case it appears (difficult because of pics) that the filler may have been placed in the eye fat rather than the groove.  In some cases, filler can be resorbed by the body quickly, particularly in patients with aberrant metabolic rates.  Best Dr. Anil Shah

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs. I would wait and allow your current results to fully mature before entertaining additional treatment.  Areas like the undereye have to be treated incrementally to avoid overfilling the area and may take more product than anticipated.  Refyne is a very thin product helping avoid lumps and bumps but can take more product to achieve the result you are after.

Steven F. Weiner, MD · Answer

The best results for you condition would be surgery. If that is not what you want, filler can be used to improve the appearance. In my experience, Refyne is good to improve small bags/tear troughs but not for the deeper problems. I tend to like Defyne of Restylane for patients like you. These fillers have more support and give a more robust filling. Always have your provider use cannulas for this injection to minimize side effects and risks. Often, a sandwich technique where filler is placed above and below the muscle is needed to get the best results. Also, 2 different approaches are used often, one from lateral, and one from below.

Abdulla Fakhro, MD, FACS · Answer

Hey micthompson73, Your results look better, wait a bit more and see how things go. I wouldnt go back for more just yet, waiting at least 4 to 6 weeks helps a lot, the lower eyelid bags are hard to treat, you might want to see your surgeon down the line about addressing that surgically in a way to rejuvenate and remove them for you . 
Hope this helps

Travis James, DO · Answer

Thanks for your question. Before returning for more treatment I would allow more time for the product to settle to fully appreciate your results, this may take up to 1 month. Restylane Refyne is a very thin product, while there is benefit to a thin product in this area it also doesn’t elevate the area as much and requires more product. While Restylane Refyne is a fantastic product, I generally utilize Juvederm Voluma or Restylane-L in this area because they have better capability to lift the tissue to get the desired effect with less product. Although these products are my preference under the eye they are also less forgiving in this area so you want to ensure you have a skilled injector when utilizing these products in the tear trough. Good luck.

Was I a bad candidate for under eye fillers? The results were so minimal. (Photos)

Answers (10)

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