What to do about bad results? Under eye fillers seem to have made my under eyes look worse. (photo)

Question

In mid 2018, I received filler in tear trough area (from a DO, FACS) After there were obvious white mounds. In Jan 2020, the Dr told me that this was because of volume loss. He gave me filler again. It is now 2 months after the fillers and I feel the results are dreadful. I told him that I want to lose the white mounds because I look like a reverse raccoon. The Dr says he doesn't know why and he didn't have a suggestion. I would greatly appreciate any thoughts. Thank you kindly in advance!

Kenneth D. Steinsapir, MD · Answer

This product should be completely removed with a large dose of hyaluronidase, the enzyme that breaks down hyaluronic acid. This should be widely available but so many doctors and nurses doing this treatment just don't get it. I literally have people who fly in from all over the world for this service. Don't get talked into other services, laser treatment, etc. Don' live with this bad result. Get the product removed. You need about 300 units of hylaruonidase. The enzyme does not wreck your skin. Funky service wreck the skin but this is immediately fixable with enzyme. Do not let anyone talk you into grafted fat in this area. At least hyaluronic acid filler can be removed. Graft fat can be removed even with surgery. Don't let well meaning doctors steal your natural beauty.

Nima Shemirani, MD · Answer

Hi @RomiNash! 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 superficially 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. I would recommend dissolving the filler with Hylenex. Best of luck to you!

James R. Gordon, MD, FACS, FAAO · Answer

Have the filler dissolved by an eyelid specialist, oculoplastic surgeon, and the reinjected. Good luck!

Jason Emer, MD · Answer

Unfortunately this filler cannot be dissolved with Vitrase / hyaluronidase. A combination of fractional laser or radiofrequency, Venus Legacy treatments, and 5FU/steroid injections could help. Otherwise, aside from waiting to see if it goes away, the only other permanent option is surgical removal. I suggest getting a formal evaluation with a cosmetic dermatologist. Best, Dr. Emer.

Mehryar (Ray) Taban, MD, FACS · Answer

It is best to dissolve the filler and then re-evaluate. You may not be good candidate for filler and may instead benefit from lower blepharoplasty. Need evaluation.

David C. Mabrie, MD · Answer

Hi RomiNash,
we are sorry to hear that you have been dealing with this situation for such a long time.  Treating the under eyes (tear troughs) is an anatomically challenging area.  From your description and photos, it appears the issue is stemming from an inappropriate placement of the filler - it was not placed at the correct depth.  
To properly treat the under eye area it is important to treat adjacent areas (particularly the larger midface and cheek) to support the orbital rim and tear trough.  Ignoring these “support” areas can create heaviness under the eyes or pooling of filler — the exact opposite of our goal.
To correct your results we recommend dissolving the old filler that is trapped beneath the skin with Hylenex (hyaluronidase). You may need a few rounds of dissolving before refilling the under eyes. 
Make sure to do your research and find an experienced injector who specializes in treating the under eyes. 
Here is a video that further explains what hyaluronidase is and how it works. We hope this helps.  Good luck and stay beautiful!
~ Mabrie Facial Institute

Camille Cash, MD · Answer

I'm sorry you are having issues from your filler treatment.  Based on your photos I recommend visiting with a board certified plastic surgeon and having the filler completely dissolved.  You can then be properly evaluated to determine the best treatment for you.

Dennis Gross, MD · Answer

The skin around the eye area is THE THINNEST on the face- meaning our approach to any procedure in this area needs to be gentle and conservative. If the filler that was used was Hyaluronic Acid based it seems like you could use some hyaluronidase enzyme to start to reduce the amount of filler in this area. This should be done over the course of a few visits in order to not "over-reduce." After these treatments are completed it may be a good option to do some light laser to stimulate natural collagen in this area to smooth and tighten.

Leonard Grossman, MD · Answer

Unfortunately what you're going through is too common in the patient population. Too many doctors and even non-physicians are injecting people all over the place. The tear trough area should be treated with the patient's own fat and preferably no fillers should be used. But fillers are too easily obtained and that's the reason for their use. The majority of fillers such as Restylane or Juvederm when injected into the lower eyelid tend to move from the squeezing of the orbicularis oculi muscle making the product concentrate near the nose where your lump is. Seeing you in person of course would be best and I would go to a plastic surgeon who can dissolve the filler with hyaluronidase and correct the hollowness with the use of your own fat. As long as your plastic surgeon is experienced in fat grafting techniques, the results should be natural and permanent. I would also bring photographs of you prior to any treatment. I hope this helps and good luck from New York City plastic surgery

Matthew Sniegowski, MD · Answer

Thank you for your question. If you notice an elevated area immediately following your filler injection it is sometimes possible to gently massage the area and it will even out. If you are two months from your injection and dissatisfied with your results, assuming you were injected with a hyaluronic acid based filler (Restylane, Juvederm, etc) the filler can gradually be reduced with injections of hyaluronidase. I would recommend discussing hyaluronidase with your injector.

What to do about bad results? Under eye fillers seem to have made my under eyes look worse. (photo)

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