Under eye puffiness after fillers and profhilo, should I dissolve? What may happen? (photos)

Question

I have had teartrough (teosyal redensity) 18 months ago and cheek fillers injected onto bone correctly I believe over the past 6 months . I had no problems until I had profhilo and after my second profhilo session almost overnight I developed malar lines and puffiness under one eye. It has been 2 months and no real improvement. It looks very bad under overhead lighting. Considering dissolving but very worried about dissolving my tissue and also considering Morpheus 8 to try and reduce eye bag

Raffy Karamanoukian, MD, FACS · Answer

Filler migration and permanence is a very common problem because there are many different types of HA fillers on the market and each is specified for a specific part of the face. Use of highly cohesive fillers on thin skin may cause swelling and nodularity. If patients have filler migration or nodules, we recommend a combination approach of filler reversal with enzymes Hylenex and Hyaluronidase in different strengths to dissolve the filler. We may also need to add Kenalog to the mix in order to reduce fibrous tissue. If the filler does not dissolve, it either means the filler is not HA material or we need more enzyme. The HA reversal can be combined with other lasers and skin treatments at the same time, and it usually (usually) does not affect adjacent tissue.

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Jason Emer, MD · Answer

Fillers like Belotero, Volbella, and Restylane Silk are good for improving under the eyes and would help in your situation to contour after your profhilo injections, but keep in mind that a combination approach will give the most improvement.  My patients try to get non-surgical treatments to avoid surgery, so we use fillers, lasers, plasma pen, microneedling/PRP and stem cells, cosmelan peels, and microneedling radiofrequency like Fractora or Morpheus can all help give some improvement. Accutite can often be used or stronger lasers like Erbium or CO2 spot treatment can tighten the skin around the eye and give very quick improvement in wrinkles and texture.  I suggest you get a formal consultation to see what is best for you and your goals.  Best, Dr. Emer.

Leonard Grossman, MD · Answer

Unfortunately too many people are having issues with hyaluronic acid fillers being injected into the lower eyelid area. they're two components that come into effect here that affect the outcome. Number one, the orbicularis actually muscle tends to push the filler towards the outer edges or towards the nose where a new bulge presents itself. Number two, because the skin is so thin there is what's called a Tyndall effect In other words the skin becomes kind of blue in that area. treating this error with hyaluronidase must be done in a very careful manner as not to destroy healthy tissues. I recommend doing this in very low concentrations using hyaluronidase and repeating the process at two week intervals for as many as three times. once the situation has been corrected I recommend using only the patient's own fat to treat the tear trough. When fat grafting is done by a plastic surgeon with lots of experience in such procedures, the results are natural and permanent. I hope this helps and good luck from New York City plastic surgery

Under eye puffiness after fillers and profhilo, should I dissolve? What may happen? (photos)

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Under eye puffiness after fillers and profhilo, should I dissolve? What may happen? (photos)

Answers (3)

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Everything you need to know about RHA Redensity

Our mission is to create a world where every investment in modern beauty is Worth It.