Juvederm Voluma XC injected in the under eyes? Should I continue or switch?

Question

I have under eyes hollows. One doctor was great explaining / examining & suggested Restylane for the deeper parts & silk thinner part. 2-3 syringes needed. Another doctor suggested VOLUMA XC. Said I would only need 1 Syringe. I went with her & I hardly notice a difference. One eye has more " she has some me left". Do I go back & get another syringe & trust it will look better or go with the first doctor & start over. I am not happy with results VOLUMA is said to last up to 2 yrs.

Leonard Grossman, MD · Answer

In my humble opinion NO hyaluronic acid fillers should be used in the under the eye area as it produces a Blue Lake Effect. This does not happen right away, but does happen over a period of time. Most patients with lack of volume in the lower eyelid must have fat grafting as the only safe procedure. The results will be permanent and natural-looking.Good luck from New York City

Alex Eshaghian, MD, PhD · Answer

Thank you for your question vnsal799. I am sorry to hear about your
situation. Juvederm is a hyaluronic acid filler designed to enhance the
appearance of the face. Different doctors prefer different fillers. I prefer a softer filler such as Restylane or Volbella in the tear troughs. These have the advantage of decreased swelling. When we have patients who are unhappy with their results we ask them to return to the office for correction. Please consult with a doctor for specific recommendations. Good luck!

Faiyaaz Kalimullah, MD, FAAD · Answer

Thank you for your question.  It's difficult to make exact recommendations without assessing you in-person, or at least reviewing your before and after photos.  That said, generally speaking, the tear troughs and the under eyes are some of the most difficult areas to treat with fillers, and require a great deal of experience and expertise.  There are a number of hyaluronic acid fillers that can be used in this area with good results - the exact product selection depends on a variety of factors, including your specific facial anatomy and bone structure, the thickness of your skin, and the extent of fat/volume loss that needs correction.  I have used Voluma in this area with excellent results, but only in properly selected patients.  I also generally recommend against Restylane Silk in the tear troughs, as I have noticed it has a tendency to cause excessive swelling after treatment.  I think the best approach is to go slowly, and build volume with time, as it is much easier to add additional volume as needed than it is to break down unwanted filler.  I would also recommend seeing only an experienced cosmetic dermatologist or plastic surgeon for any future injections.  Best of luck!

Christopher Dannaker, DO, MPH, FAAD · Answer

Both physicians are likely correct.  Often patient require a deep injection of filler to correct mid facial volume loss. Thicker fillers such as Voluma, Restylane Lyft and sometimes Radiesse can be used for the deep, just over the bone injections.  Then a second layer , nearer the surface is treated with a very thin filler such as Beletero or Restylane Silk.  I find that in this are Silk causes more swelling than Beletero.  Sometimes the skin is so thin, we may dilute Beletero with saline to make it less viscous.  The injection is first placed under the obicularis muscle and then a more superficial injection immediately above the muscle.  With very thin skin the more superficial injection cannot be performed. Bluish discoloration generally has not been a problem, especially with Beletero, although the amount and location of injection is important.

William Marshall Guy, MD · Answer

Hello Vnsal799,The tear trough is a very delicate area to inject.  The thin skin makes it prone to have contour irregularities and poor results when fillers are injected.  For this reason, I always stress it is important to have you injections in this area from one of the core aesthetic physician injectors (facial plastic surgeon, plastic surgeon, dermatologist, oculoplastic surgeon).  As far as the best filler for the tear trough, I prefer to use Restylane.  What is nice about this product is it does not tend to pull in a lot of water so you don't exchange a hollow for a bag (I feel Juvederm pulls in too much water when used in this area giving a poor outcome).  As far as Voluma you are correct it can last up to 2 years.  The drawback is that it is a much thicker product which makes it much more prone to contour irregularities.  There certainly are people who inject the tear trough with it but Juvederm and Voluma are the top two products I dissolve in that area from other's injections.  Of course, those who are happy aren't seeking out a second opinion with me so I don't see those who were originally happy.  As far as who you should go with and what injection, that is a decision for you and then you and your treating physician.  I would say it is always easy to add more product later if you think you didn't get enough.  If someone starts out saying 3 syringes I would personally be a little worried.  I have injected in a thin skin patient as little as 0.12 cc on each side with complete correction.  Conversely, I have injected someone twih a full syringe on each side and still not gotten to full correction.  There clearly is a range, and depending on your anatomy, you may need more, but start slow.  Yes, we can inject hyaluronidase to dissolve a bad result, but then you lose out on your original injection.  I would recommend to start gradually, add more as needed, and make sure you see a physician injector. I hope this helps and good luck.

David A. Bushore, MD · Answer

It really depends on presentation and expectations in deciding the best way to treat tear troughs. I do prefer Voluma as it gives the most lift with very little post procedure swelling due to the Vycross technology. Even though the tear trough is the visible problem, often it is important to start by treating under the lateral aspect of the eye and the medial cheek before addressing the tear trough to help keep a more natural appearance as volume loss in these areas plays a major role in the formation of tear troughs. Be sure to see an expert as this can be a very tricky area to treat.

Jacob Bloom, MD · Answer

Thank you for your question.  unfortunately, It is impossible to give you specific advice without seeing you in person.  That being said I have found great success using Voluma and Volbella to correct tear troughs under the eyes.  Depending on severity, bone structure and patient goals; I create a plan with the patient to correct this issues.  If using 2 fillers I will space injections out 2-4 weeks so that I can place the fillers precisely where they are needed.  This is a very sensitive area for injectables please select only the most experienced injectors for treatment if these issues.

Juvederm Voluma XC injected in the under eyes? Should I continue or switch?

Answers (7)

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