Dermal filler injection of the "tear trough," or undereye hollow, requires an advanced injection technique with no room for error and must be performed by a physician who routinely performs this procedure. Although Juvederm, Restylane and Belotero are all sugar-based (hyaluronic acid) fillers and are very similar, there are subtle differences between them. Juvederm is widely considered not to be appropriate for filling the delicate, thin-skinned undereye area because it often results in a lumpy, unnatural appearance. In my practice, I use Restylane Silk or diluted Restylane in the undereye area and I inject with a cannula, a device that looks like a needle but has a blunt tip. Cannulas are used to place filler under the very thin muscle layer, which results in a more natural appearance with minimal to no bruising. After 18 months and up to several years, any of the fillers I mentioned can become "swollen" and form a skin colored or bluish pocket under the eyes due to their tendency to draw in more water as they break down over time. In your case, I would recommend having hyaluronidase injections to get rid of all of the filler and then starting over. This can be a tedious and somewhat expensive process (several sessions may be required), but worth it in the end. I recommend finding a board-certified dermatologic surgeon (physician finder at ASDS website) or plastic surgeon who can show you representative photos of his or her patients treated with filler under the eyes.
Fillers are not the answer to all problems. The company wants to believe so.
When injecting fillers, what ever method or technique you use, the filler is injected with certain amount of force through the needle or cannula. The filler will spread in the tissue in the plane of least resistance. You have no control over. Also body immune reaction occure. so the results are not predictable 100%.
traditionally either the problem is minor and not worth surgery or if it bothers you, you find the best plastic surgeon and deal with the problem in a controlled manner.
My advise is to find a plastic surgeon with experience in dealing with all aspects of the lower lid, fat distribution, fat graft, muscle tightening, canthopexy.
I think that the 1st picture shows continued volume loss in the upper cheek. It definitely could use more filler. I would use Restylane there. It is hard for me to get a good evaluation of the other side... the pics aren't as good.
In my practice venus legacy and hyaluronidase are used to improve results if you are unhappy. Long term, fillers, lasers, micronedling/PRP do well for this area. Please see an expert. Best, Dr. Emer.
Sorry to hear about your situation. I agree that you need more volume around your eye, especially at the outer upper cheek/lower lid junction, and advise you to find a physician who can place voluma in the area. It's longer lasting so you'll get a good value for your money and supportive to the area.
See if you can find a certified Y lift provider in your area, the results from this particular way of placing the filler are most helpful for patients in your situation.
Thank you for your question and I am sorry to hear of your filler issues. Depending on the timing of your most recent filler placement, you may want to allow at least two weeks to pass in order for the results to soften, mature, and appear more natural. If after two weeks your results are unsatisfactory discuss them with your injector, they can either place additional filler or offer other treatment options to get you the desires you are most interested in.
It is difficult to tell from the photos if you need filler, surgery, or more Vitrase to dissolve the product. Please consult with an expert with an in office consultation to ascertain the next step for you. Best, Dr. Green