Puffy Eyes After Juvederm Injections in Under Eye Hollows

Juvederm is a hyaluronic acid-based filler that is quite soft and well-tolerated in many clinical situations. One consideration in the setting of puffiness after injection is that this type of filler is hydrophillic, meaning it attracts water. For a few days, this can be seen as swelling or puffiness, which generally resolves. Some patients see some benefit by using warm compresses to help the fluid subside. If your swelling is within the first few days after having a filler injection, this may improve spontaneously.
Hyaluronidase is an injectable substance that can dissolve filler in the case that there are lumps or bumps caused by the filler itself, not filler-related swelling. Rarely is a hyaluronidase injection necessary when fillers are placed correctly.
Fillers under the eyes can supplant surgical options in many cases. We now understand that the appearance of under eye bags can be areas of fat that are accentuated by hollowing below. By filling the grooves under the eyelids, surgery may not be required in some cases. In fact, in some cases, removing fat can create an aged or even more hollow appearance to the eyelids! Current techniques may involve fillers alone, a combination of surgery and fillers, or using native fat to restore volume.

Injecting fillers under the eyes can be very challenging because the deficit you are often dealing with is too much volume in the first place.  

Juvederm isn't an ideal filler for under eye hollows because it is considered a hydrophilic filler.  Hydrophilic refers to it's ability to draw water towards itself.  Juvederm is one of the most hydrophilic fillers on the market.  Restylane can be hydrophilic but much less so than Juvederm.  Restylane is typically the go to filler for the under eye area.  

This is a common problem. People try and fix issues that require surgery with filler. Typically we are able to improve the issue just not solve it. We never want to make things worse. A few key things need to be answered. How long ago was the injection?  depending on that it could be swelling and edema still.  If it has been over two weeks then you can consider the antidote that can absorb the material.Another thing to consider is facial fat transfer that can help with this issue. It is worth looking into if you are against surgery for now.Hope this helps.Best of luck,DrC

Please wait at least a couple weeks to see if puffiness is actually temporary swelling.If puffiness is due to product, it is likely from too much product placed too superficially.  Product can be easily dissolved with hyaluronidase.  Under eyelid skin is very thin.  I place most of the product on the bone, and, only if needed, a few very thin strands superficially.  It is better to undercorrect in this area, then to have an unnatural or puffy result.

Juvederm and Restylane are interchangeable in a lot of filling areas, but in the lower eyelids, I see a difference.  Others have reported that Juvederm is more hydrophyllic (water-loving) than Restylane and in the lower lids, I see that as a disadvantage.  For that reason, I don't use Juvederm in the lower lids, and use Restylane cautiously.