What should I do to fix under eye filler removal? (photos)

Question

Three days ago I had my under eyes injected with the enzyme hyaluronidase to remove bad filler. Now area is left sunken and hollow, I feel totally disfigured. I have read that the enzyme can remove your natural hyaluronic acid, will that come back? What can I do to correct or lessen the severity of the hollowness? Will having new filler injected with a cannula close to the bone help or do I need surgery? Please help

Raffy Karamanoukian, MD, FACS · Answer

Filler migration, swelling, and granulomas can cause significant discomfort and cosmetic ramifications. Our office specializes in the use of enzymes and filler reversal techniques without hyaluronidase to help improve the results of botched cosmetic fillers, whether caused by Juvederm, Restylane, or foreign fillers. Our plastic surgery institute provides expertise in filler removal. We begin by examining the facial fillers and assessing the likelihood of fluctuance or liquid volumization. If appropriate, we use Hylenex, or other filler reversal agents to reduce swelling and filler migration. Hylenex can be targeted into the areas of concern using multiple layered injection techniques. If the filler does not completely resolve, then additional concentrations may be employed. The technique has the potential to reduce the filler and may slightly impact normal hyaluronic acid. Treatments are repeated and results can improve immediately and with time.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Harold J. Kaplan, MD · Answer

Hello Chipper.  The enzymes used to dissolve filler do not break down natural hyaluronic acid.  What they do is break the bonds that hold together synthetic Hyaluronic acid molecules.  Now that you have dissolved the previous filler, you can start over with a new injector and/or new filler.  The choice of a cannula vs needle does not matter as you can inject deeply against the bone regardless of which tool is used.  It would be more prudent to find a great tear trough and eye injector than worry about which tool they use.

Jean M. Casello, MD · Answer

Sorry that you had a bad experience with under eye filler.  This is an advanced area to inject  and it is best to go to an experienced injector. The hyaluronidase should not dissolve your own hyaluronic acid as it works to break the bonds of the product.  Looking at your photos it apprears that you have volume loss in this area and probably in the cheeks as well.  Your options would to get injected with an HA filler again or think about a fat transfer procedure.  The tool that is used  needle or cannula should not affect the outcome. Please don't dispair this is can be addressed by either of these methods in the hands of a competent provider.

Supriya Tomar, MD · Answer

So the good news is that you didn't lose an of your natural hyaluronic acid, and even if you did it will come back on its own naturally. Normally, for something like this I would recommend getting hyaluronic acid fillers by a reputable injector, however, I'm sure you're not ready to try that again just yet. Another option would be RF to stimulate collagen production in the area again with EndyMed Skin Tightening or Genius RF (I would recommend Genius for more noticeable results). It will take a few weeks after your first treatment to start seeing the real results (there will be some swelling initially), and you may need a few treatments to completely get rid of your hollows. But the good news is it will look much more natural than filler or a surgical lift. You can also pair your treatments with a hyaluronic acid eye cream or retinol eye cream to kickstart the plumping process. Hope this helps, and good luck!

Darryl J. Blinski, MD · Answer

I would recommend nano fat grafting in micro droplet techniques with cannulae only. Fee in $3,000 ranges. Best to see only boarded surgeon.

Elizabeth Liotta, MD - Account Suspended · Answer

The best thing you can do to improve sunken and hallow under eyes would be adding filler to the bone. Hyaluronic Acid dermal fillers are great for the under eye area because it tends to look more natural and smooth, and your body could potentially produce more collagen and hyaluronic acid with the filler being present in the skin. I would suggest waiting a few weeks before adding filler back into that area, you want to wait for the enzyme to be completely out of your system and it will also give plenty of time for your skin to heal in between treatments. Using a good under eye moisturizer can help improve the appearance of your under eyes, but adding filler would most likely give you the best results!

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