Treating Stubborn Juvederm and Fluid Bags in Lower Eyelids?

I had deeply injected Juvederm 10 months ago for lower lid hollowness. An overfill occurred, giving me bags and distorted lids. Several rounds of Hyaluronidase injections have reduced the bags by only 25%. Months later I am still left with bags. When I apply finger pressure it sometimes resembles fluid, with some firmer areas. There was no prior bagging or puffy lids before the filler. I'm 30 with no allergies. Eager to fix this & sad. Try more Hyaluronidase or maybe need the fluid cauterized?

Doctor Answers 9


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I firmly believe lower eyelid injections with Juvederm are excellent but must be done on a serial basis.   I have inadvertantly become a local referral center for hyluronidase treatment after Juvederm or Restylane mishaps.  I bought the kit for one of my patients so I was the local guy with the hyalronidase.   The biggest problems are the patients that had large amounts injected at on setting.  This is not ideal.  Do  2 or 3 small treatments and this will not happen.  Once it does happen, I have found the following will work.   Stick with the hyluronidase. It will work.  If the batch your doctor is using is not working, ask the doctor to order new and current hyaluronidase.  It must be kept refridgerated so if left out it is useless.   It must be in date.  I am convinced there are simply weak batches of hyluronidase.  Hyaluronidase is expensive and must be ordered in 12 vial lots.  Each vial must be used once and tossed.  I have found in resistant cases that simply using a little more and a little stronger usually does it.  In summary......Hyaluronidase will work but it must be a new batch that has been well treated and refridgerated.  Like fine wine, if mistreated it is useless.   DO NOT DO SURGERY.  YOU WILL BE MUCH WORSE.  I HAVE SEEN THIS HAPPEN ALSO.     Hyaluronidase always wouks if done PROPERLY.  Keep the faith but insist on the above. Because it is costly some may be tempted to use outdated stuff.  Cant do that.  As wonderful as hyluronidase is it is a very very fussy product that demands much love and care and attention to guidelines.   Also check your pre op photos to be sure you are perceiving  things correctly.  Live Forward.  Dr Commons

Hyaluronidase works for Juvederm overfilling

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I would ask how much hyaluronidase (Vitrase) has been used under the eye.  I would be willing to bet that a conservative total amount was used.  I would consider re-treatment--Vitrase will melt away excess filler and usually works within 24-48 hours.  I would also be curious what your before photos looked like.  Did you have any lower eyelid fullness prior to treatment.  I often screen patients prior to tear trough/lower eyelid filling to screen for those that might have problems with lymphatic/fluid drainage in the area post-filling.  If the above measures do not work, radiofrequency technology like Refirm or Thermage might prove to be of some benefit.  I also prefer, in most cases, to use Perlane or Restylane in the undereye area.  I find it is less likely to migrate and "stays put" in the area of injection.

Melanie D. Palm, MD - Account Suspended
San Diego Dermatologic Surgeon

Fluid bags under eyelids after filler with Juvederm

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Hyaluronidase does come in different forms and the number of units may vary from doctor to doctor as to what is injected.  Patients who have such conditions may need a consultation with an oculoplastic or plastic surgeon to ensure that the bags are fluid and not fat that has herniated out from deeper tissue as that would require surgery to correct it, but your history is most consistent with fluid retention.  Further hyaluronidase treatment may help.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 39 reviews

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Lower Eyelid Swelling after Juvederm or Restylane Treatment

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The loose skin under the eyes and above the bone that defines the lower edge of the eye socket can be problematic after the injection of fillers, such as Hyaluronic Acid, Collagen, Radiesse, or Artesense.  The reason for this is that the filler takes longer to disintegrate in this area.  The first time I saw this was in 1982, in a patient treated in another clinic, shortly after injectable Collagen was introduced.  It took about 6-9 months for this to resolve on its own.  With Hyaluronic acid fillers (Juvederm, Restylane, etc.), we can use Hyaluronidase, an enzyme that dissolves these fillers and helps the lumpiness go away more quickly.  If you had Botox treatment at the same time, this can weaken the muscles around the eye that constantly "pump" away excess fluid.  The decreased pumping effect can lead to fluid accumulation (edema) around the eyes, which generally approves over 3-4 months, as the Botox effect lessens.  You should be assessed by an expert Dermatologist (or Plastic Surgeon) with particular experience in using fillers and hyaluronidase.  Good Luck!

Sheldon Pollack, MD
Toronto Dermatologic Surgeon

Best Treatment for Stubborn Juviderm and Fluid Bags in Lower Eyelids

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HI Raleigh,

Hyaluronidase needs to be injected right where the Juviderm was injected.  Unfortunately sometimes there is some residual swelling that is difficult to resolve.  I have tried systemic steroid injections (Depomedrol intramuscularly) with some success in these cases.  If still persistant, then treatment with Fraxel repair and/or Ulthera ultrasound may help.  Best to discuss with an experienced physician.  Good luck, be well, and I hope that your puffiness resolves quickly.

Dr. P

Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 39 reviews

Swelling after Juvederm undereye

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You likely need more or even serial hyaluronidase injections to completely dissolve the filler. I would follow up with your injecting physician to inquire about doing this.  Good luck with your recovery.

Juvederm and Fluid Bags in Lower Lids

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Hyaluronnidase placed in the Juvederm should dissolve it. I prefer to use Restylane rather than Juvederm in the lower lid orbital rim because the Juvederm tends to be hydrophilic (absorbs water). Hopefully your problem will be short-lived.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

Juvederm and eye bags

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It is always nice to see pre-treatment phots. Often these bags are present. Only the injector will know where the juvederm was placed. If it is due to juvederm, then hyaluronidase will dissolve it.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews


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Whoever injected the Juvederm knows where and at what level the juvederm was injecte. The hyalorinidase should be ijected at the same level. Cauterization ???? what is that>|????

See a board certified plastic surgeon for proper examination and diagnosis. Once that is made then a plan of treatment can be presented to you with options, and potential risks.

Samir Shureih, MD
Baltimore Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.