Can filler be removed during lower eye lid surgery?

Usually both the injection of the enzyme and removal of residual filler during surgery are performed to manage filler in the under-eye area. Even though the enzyme is injected in the soft tissue, it does not fully remove the filler. It is difficult to remove the filler during surgery, so dissolving as much as possible beforehand is very helpful. The reason it is difficult is that there are little droplets of the filler are found throughout the soft tissues and they are not sequestered to a specific plane of tissue. This is in contrast to native anatomic structures which stay within certain boundaries that confine them.

You cannot physically remove Fillers. Fillers become incorporated into the interstitial space in the tissues themselves. You can’t separate or identify filler and separate them from live tissue. What your surgeon is suggesting makes little sense. If you have HA-based fillers, then they should be dissolved and somatically before your procedure to get an accurate anatomic baseline for the cosmetic procedure. Each provider will have their own way of doing things.
Historically, oral surgeons are not trained in blepharoplasty surgery, but if he has experience with a proven track record, then perhaps he’s the right person for the job. I am not trained in oral surgery, so I’m certainly no expert on oral surgeons scope of practice.
Generally speaking, I recommend patients have multiple in person consultations before selecting providers. The biggest mistake patients make is having only one consultation, then scheduling surgery. Without having multiple consultations, you have a little reference for deciding who is the better provider. During each consultation I suggest asking each provider to open up their portfolio and show you their entire collection of before and after pictures of previous patients who had similar facial characteristics to your own for whatever procedure you are contemplating. An experience provider should have no difficulty showing you the before and after pictures of at least 50 previous patients. in fact, highly experienced surgeons should have hundreds or preferably thousands of before and after pictures to choose from. Being shown a handful of pre-selected images, representing only the best results of a providers career is insufficient to get a clear understanding of what average results look like in the hands of each provider or how many of these procedures they’ve actually performed. In the end, patient candidacy, and provider selection are generally the most important variables. Having had fillers in the past, probably isn’t that much of an ordeal, but it can potentially have an impact, depending on how much filler, and how recently you had it injected.
When, in doubt, slow down and schedule more consultations.
Best,
Mats Hagstrom, MD