How do I get rid of scar tissue under eyes after fillers (fat and juvederm)?

Question

I’ve had filler injected in my tear troughs 4x - 3x with my own fat with an 18g needle, 1x with juvederm. Last injection 5 years ago. I’ve had persistent lumps under my eyes, initially believed to be juvederm and was treated twice with hyaluronidase without resolution. 2 years ago, a PS performed a transconjunctival bleph and removed scar tissue (a decent amount, according to him). However, I still have visible lumps and really want them gone. What are my options? Repeat bleph? Thank you.

Jonathan Kulbersh, MD · Answer

I recommend getting a consultation. This may be improved with 5/FU steroids or surgical removal. I hope this helps.

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs and I am sorry to hear of your difficulties.  I would recommend seeing an oculoplastic or plastic surgeon in consultation to see and feel the tissues of your lower eyes.  Based on your narrative I would assume that this is poorly placed fat from your 3-4 treatment sessions that would need removal in order to improve your results.  This requires an in-person evaluation, however.

Gregory A. Buford, MD, FACS · Answer

Without photos, there is really no way to give you guidance here.  My suggestion would be to seek out a Board Certified Oculoplastic, Facial Plastic, or Plastic Surgeon and meet with them in person to discuss your concerns.  I hope that helps and wish you the very best!-Gregory A Buford MD FACSBoard Certified Plastic Surgeon and Author

Jason Emer, MD · Answer

I recommend getting a formal evaluation with a facial sculpting expert. Lasers, microneedling/prp, rf treatments may give improvement. Best, Dr. Emer

Marek Kacki, MD · Answer

I am sure you could get help from Plastic Surgeon who does fat transfer and is familiar with this type of complications. Since you have practically eliminated the possibility of filler accumulation with hyaluronidase injections there are few non-surgical options that may be considered. Steroid injections may help if scar tissue is the problem, not so much for fat. I had very good luck with using radio-frequency for the same problem in the same location and in the lips. I used Exilis but in a very modified manner. It is a very small surface area to heat and little room to "escape" with the probe. Since the fat residual is most likely mixed with, or surrounded by, the scar tissue it requires different handling to achieve high enough temperature in this very sensitive area. You can almost eliminate discomfort and reach high temperatures by pre-injecting the area before the treatment. Good luck!

Leonard Grossman, MD · Answer

That is quite unfortunate what you're seeing on your face. If you're absolutely certain that hyaluronidase was used and did not resolve the issue whatsoever, I would recommend that you are seen in person by a plastic surgeon like myself. If this is definitely not a hyaluronic acid filler and let's say scarred fat, then injections of Kenalog might be of help but please make sure you see a specialist. Good luck from New York City

Sara A. Kaltreider, MD (retired) · Answer

This is a very difficult problem to treat. The challenge is removal without additional scarring or irregularity. Ideally this tissue or filler could be removed through a transconjunctival approach, but this could only be determined with a "hands on examination". You may want to seek two or three opinions prior to taking action. Be sure to ask your surgeon if he/she has dealt with this problem before, and how it was approached. An experienced surgeon will be able to improve the appearance of your eyelids. Best wishes.

Val Lambros, MD, FACS (retired) · Answer

this is the problem with grafted fat under the eyes. Steroids and 5FU are often mentioned as treatment but don't work. Surgeries are limited by exposure and if the fat is under the skin in the muscle and on the bone it is very difficult to get to it/ Sometime surgery makes it worse or you trade one deformity for another. I've struggled with this for years and there is no great answer. There is some interest in using Kybella for this but until further experience is  gained I would not do it.

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