Tear trough filler over-fill? Bags are way worse when I smile. (Photos)

Question

Hello. I received tear trough filler 4 months ago. 1 syringe of Restalyne and 1.5 syringes of Volbella. The first pic is current with no smile, and the 2nd pic is with me smiling. I look worse than before I got the filler. "Bags" are way worse when I smile. What can be done? Thanks

Michael A. Zadeh, MD, FACS · Answer

We would need to see both a before and after picture with you smiling to make an accurate assessment. The amount of filler you are describing seems excessive for the tear troughs. If you are not happy with your results then you can have the filler dissolved with Hyaluronidase. Make sure you seen an experienced injector next time. Best wishes.

Nima Shemirani, MD · Answer

Hi @NewpsMama! I'm sorry you are not happy with your results. I recommend dissolving the undesired filler with Hyaluronidase. Best of luck, Dr. Nima!

Mehryar (Ray) Taban, MD, FACS · Answer

I recently published my results in performing lower blepharoplasty in patients who have had poor experience with filler injection. See following website link with has link to the publication and other information. Skype consult available.

Jason Emer, MD (license on probation) · Answer

If you're unhappy with your final results, you can have it reversed with hyaluronidase and try a different technique next time. Keep in mind, a combination approach is needed for improvement under the eyes. I recommend fillers with lasers and microneedling/prp. See an expert. Best, Dr. Emer

Daniel Barrett, MD · Answer

Dear NewpsMama,wrinkles and/or bags under the eyes is the number one complaint of may people as we age.
To treat the area, it requires an experienced clinician and multimodal therapy based on severity. Sometimes surgery is the answer, other times a light filler with a peel or laser will do the trick.
Always make sure you know the credentials of your clinician and what products they are using. You can wait for the effect of filler to diminish.Daniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery  
Member, Am. Society of Plastic Surgery

Hratch Karamanoukian, MD, FACS · Answer

The technique here may have caused this issue with "overfill" as the plane of product placement which causes fat pad displacement when you smile. You should have the product dissolved and start over again with a single vial of Restylane or Belotero.

Harold J. Kaplan, MD · Answer

Hello, We would like to offer an opinion that differs from panel members.  The photos offer only a limited assessment as we prefer evaluating the face as a whole as well.  However, it would appear that your filler was placed in the wrong location regardless of the amount or type of gel filler.  When you smile, you are now experiencing a more apparent demarcation as if there was filler placed in the cheeks as well as too high and away from the actual hollow area.  If this is the case, the act of smiling exacerbates this appearance.  We disagree that tear trough treatments with filler always leads to puffiness or the Tyndall effect as suggested.  This is only happens when the filler is not placed in the proper plane or depth of this delicate area. Without an in person evaluation, we are only able to offer a general treatment option of reducing over-filling with hyaluronidas as well as using a gel filler to better blend the transition of the lower treat trough area to the fullness of the cheek.  In this way, whether the face is neutral or animating, (rest or smiling) your appearance will be better blended.Tear trough treatments are the most favored filler treatment we perform for both men and women.  We also perform many corrections for patients that were treated elsewhere with unsatisfactory results.  The below link demonstrates what corrections look like.We have a local office in your area, so feel free to reach out to us for a complimentary consultation.

Melvin Elson, MD · Answer

There is absolutely no way that amount of material can be injected for the tear trough. the photos are of no help but if you are having difficulty with overfilling then see a board certified dermatologist and have hyaluronidase injected and start over with no more than 1cc of material preferably Belotero

Arian Mowlavi, MD, FACS (license on probation) · Answer

Tear trough filler in the lower eyelids not a good idea. It will leave your with many years of puffiness and blue hue, called Tindel effect. Please consider a lower blepharoplasty instead.

Tear trough filler over-fill? Bags are way worse when I smile. (Photos)

Answers (9)

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