Second opinion: I had cheek filler to help under eye puffiness and now eyes look hollow and worse, any suggestions? (Photos)

Question

The muscle that runs from the inner eye close to the nose to the middle bottom of under eye is now popped out giving my eye a hollow weird appearance. Help! I look older and worse than before and I am freaking out. She used Voluma .5 ml in each cheek area surrounding the bags to help hide them but It’s strange now. She is suggesting Botox or more filler now but I am curious if I should just dissolve filler I will attach a photo from before and now after for reference. Any help appreciated!

Jason Emer, MD · Answer

Fillers like Belotero, Volbella, and Restylane Silk are good for improving under the eyes, 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, microneedling/PRP and stem cells. I suggest consulting with an expert to develop a treatment plan best suited for you. Best, Dr. Emer

William Dougherty, MD · Answer

Infraorbital hallowing is a common concern even in young patients, like you! Voluma is a good filler for deep injection to augment the cheek, chin, or jaw contour. I would not recommend it for the infraorbital region (under eyes). The great thing about the HA fillers is that they can be dissolved, if needed. I would recommend a different filler for the infraorbital area, such as Restylane or Volbella. It is best to avoid products that are very hydrophilic in this area. Hope this helps- good luck!

William Dougherty, MD

William Dougherty, MD

Tom Parmakellis, MBBS · Answer

Hi Heather,You are right in questioning whether to inject more filler. You need to dissolve the filler first and wait two weeks (until all of the product has disappeared and swelling has subsided) to review if fillers are your best option moving forward. From your photos I can see that the filler under your right eye has not been correctly placed and adding more will only highlight the problem.Kind regards,Dr Tom ParmakellisLookfresh Cosmetic Medicine

Alix J. Charles, MD · Answer

Thanks for your question and the photos you attached. You can always dissolve the current filler and start again from scratch. I prefer injecting Restylane deeply onto the cheekbone to help with this problem, although fat grafting is also an excellent option (albeit more costly). Make sure your physician injector has experience in treating this area. Best of luck to you!

Ahad Mahootchi, MD · Answer

You can always dissolve filler and start again. It's hard to say whether more filler in a different spot would be beneficial.If I had to guess the before picture doesn't show puffiness--it actually shows volume loss in the lid itself and your very nice cheekbone is more obvious.Fat grafting and lower eyelid problems like yours are expert level stuff. I love fat grafting ( so much I had it done myself) but the lid is trickier and how you process and deliver the fat is the key.See an oculoplastic specialist experienced with those nuances.Best of luck to you.

Leonard Grossman, MD · Answer

It's actually not the muscle bulging under your eye but the filler itself. There is no muscle present between the nose and approximately one-third of the lower eyelid. The orbicularis oculi muscle actually squeezes in the filler and pushes it towards the nose. In my opinion voluma is not the right product and should probably be removed but at the same time you need to be seen by a plastic surgeon who specializes in fat grafting. Once the voluma is dissolved with the use of hyaluronidase, fat grafting should be performed. Fat grafting should produce natural and almost permanent results. I hope this helps and good luck from New York City plastic surgery

Second opinion: I had cheek filler to help under eye puffiness and now eyes look hollow and worse, any suggestions? (Photos)

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