How can I correct the puffiness and bruised look under my eyes? Will dissolving the filler restore my natural look? (photos)

Hi @nanatp. Most facial filler products that are injected into this area should ideally be placed in the tissue plane directly on top of the bone, or at least underneath the eyelid muscle layer. If a facial filler product is placed too superficial in the skin, or on top of the muscle layer, the product may settle in with an abnormal appearance and can look to be lumpy, swollen, or irregular. The filler products that are preferred to treat this area will have some degree of affinity for water molecules so all of these products will exhibit some degree of hydration and swell once injected into the body. Hyaluronic acid facial filler products that were previously injected into an improper tissue plane can be dissolved by hyaluronidase injections.

Best of luck,

Dr. Nima

Longterm filler problems include migration, edema, and nodularity. 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

Hi and thank you for your question! To be able to make a more accurate assessment, we should also see pictures taken before the filler treatments, but just based on the look and your description, you appear to have some overfilling and somewhat superficial placement of the filler (causing the bluish discoloration or Tyndall effect. There are various fillers in the Juvederm family and among them, Juvederm Volbella is one of my favorite fillers for under the eyes. Other options include Belotero or Restylane, and you should stick with hyaluronic-acid-based fillers for under the eyes. At this time, hyaluronidase enzyme injection appears to be the most reasonable course of action. I personally prefer a more gradual and conservative approach to ensure we don't do over correction. I hope it helps and good luck!  

Juvederm shouldn't be used under the eyes . you do need tightening to this area based on the look and an at home peel or micro rolling would help at least now prior to you getting the filler reversed.if you are worried about your filler results because there is swelling, lumps or bumps, give it 2 weeks to settle and then consider reversing it with hyaluronidase.   in the mean time you can use redlight such as lightstim, radiofrequency such as exilis ultra and venus legacy.  The cheeks always should be injected when doing the under eye and you maybe swollen because of poor techniue so see an expert for the best treatment and management.  Best, Dr. Emer.

I’m sorry to hear about your poor results. Juvederm is the wrong filler for the undereye area. Most people use Restylane in that area. Juvederm absorbs more water and has a higher risk for puffiness and blue discoloration. It can be dissolved with injections of hyaluronidase. As far as who to see for treatment, I would start by reading the doctor reviews on this site and see if you can get any specific recommendations for your area.Regards,Dr. Ort

The problem is that you had the wrong filler placed in the wrong place. Juvederm Ultra (what most people mean when they say just Juvederm) is definitely the wrong one. However, Restylane is also wrong. Many physicians still use it because it was one of the first that did reasonably. We now know that using a heavier filler like Radiesse or Juvederm Voluma (my personal choice) and placing it deep and below the orbital ligament instead of superficial and above the ligament like you had, prevents the problems. It is probably too late to try and dissolve the old filler. When what you have wears off, make sure you choose a truly expert injector.