Looking for additional opinions to improve appearance of lower eyelids after filler and Vitrase (Photo)

After two years I decided to have Juviderm dissolved from my tt. Has not completely gone away and caused puffiness and droopiness and what I was informed is called the Tyndal effect. Both sides look very different and I think it's quite obvious that something is not right. Consulted with an oculoplastic surgeon who dissolved the filler. She thinks a conservative lower transconjunctival blep with fat repositioning and some tightening (skin pinch?) will help. Looking for some other opinions.

Doctor Answers 3

Filler dissolving and lower eyelid blepharoplasty

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The photos that you have provided are quite helpful.  I would agree with the recommendation of the surgeon with whom you had consulted.  There appears to be fat herniation of the lower eyelid.  A careful physical examination will determine the need for pinch excision.  Lower eyelid fat repositioning via a transconjunctival blepharoplasty with a conservative pinch excision if necessary is a conservative and extremely effective approach to managing your particular lower eyelid issue.  Injection of a little more Vitrase prior to surgery may also be of some benefit.

Chevy Chase Facial Plastic Surgeon
4.8 out of 5 stars 34 reviews

I agree with your Oculoplastic surgeon

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While an evaluation is the best way to advise you, what I see in your pictures is true fat prolapse in each lower eyelid, as well as residual Juvederm at the edge of the cheek just below the tear trough. I would first go further with the Vitrase and continue to dissolve the filler until none is visible, and then go ahead with transconjunctival lower blepharoplasty with fat transposition to correct both the fat prolapse and the tear trough. Best of luck!

Elba Pacheco, MD
Annapolis Oculoplastic Surgeon
4.3 out of 5 stars 7 reviews


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Thank you for your question. A lower transconjunctival bleph with fat repositioning and use of the "pinch technique" may be beneficial for your face, however, I suggest that you consult with a board certified facial plastic surgeon. That way, the board certified facial plastic surgeon can review your health profile, concerns and desires during an in-person examination and provide you with recommended options.

Best wishes,

Ross A. Clevens, MD
Melbourne Facial Plastic Surgeon
4.7 out of 5 stars 124 reviews

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.