Under eye puffiness - Would you recommend PB Serum, doxycycline, Kenalog, or another treatment? (Photos)

Question

I’m looking for treatment recommendations for persistent under-eye puffiness. I had lower blepharoplasty 4 years ago and under-eye filler 2 years ago, which caused puffiness that never resolved despite dissolving the filler multiple times. Six months ago, I had under-eye fat repositioning, but the puffiness remained unchanged. A recent ultrasound showed no remaining filler or significant scar tissue. I’m wondering if it could be trapped fluid, impaired lymphatic drainage, or residual fat. Would you recommend PB Serum, doxycycline, Kenalog, or another treatment?

David Hill, MD · Answer

The photos are hard to read, so I can't tell much from them. Going by your history, I'd do one more round of Hylenex (hyaluronidase) to be certain no filler is left. Small amounts under the eye can be missed on ultrasound, and leftover filler holds water and keeps the area puffy.
If the puffiness stays after that, the most likely cause is impaired lymphatic drainage. Filler, surgery and fat repositioning in the same area can all slow the drainage of fluid under the eye. It's usually worse in the morning and after salt, alcohol or allergies.
I'd be careful with Kenalog here. A steroid under the eye can thin the skin and leave dents or white spots that are hard to fix.

Under eye puffiness - Would you recommend PB Serum, doxycycline, Kenalog, or another treatment? (Photos)

Answers (1)

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