Lower Bleph with Fat Repositoning to Remove Filler Bag? (Photo)

Thank you for your question and for sharing your photographs. The most precise mechanism to determine whether there is still injectable filler in the lower eyelids would be an MRI scan. However, it is somewhat difficult to justify this considering the problem you are still experiencing.

The contours of the lower eyelids usually take six months, and sometimes a little bit longer, to stabilize. I would imagine that your surgeon would also want to allow this time before having injectable filler treatment in the front of the cheek to adjust the contours.

If you do want to obtain an MRI scan and it does not show residual filler, you may discuss with your surgeon whether a small reduction of the fatty tissue on the right side is your best solution.

I would recommend dissolving the filler with hyaluronidase. This filler was likely not placed in the correct location. It appears that this filler is behind the orbicularis muscle in one of the potential spaces of the lower eyelid. The best option in my opinion is to dissolve the filler and then perform a lower eyelid blepharoplasty with fat grafting.

You did not need surgery to remove the filler provided the filler was a hyaluronic acid filler. The filler is removable by placing the enzyme behind the orbital septum and using a sufficient amount of hyaluronidase enzyme. I have treated hundreds of these without resorting to surgery but it requires a clear understanding of the needed dose of enzyme. Generally I will treat these with 150 units of hyaluronidase. Now that you have had surgery, you should wait at least 2 months in my opinion before having filler placed. Please understand that the placement of filler is fussy and it may be beyond the skill of most injectors to obtain a great result. I strongly warn you against ever having grafted fat in this location.