Hyaluronidase Treatment to Reduce Under Eye Puffiness/Swelling

I first had dermal filler in my upper cheeks in 2011 and nasolabial folds in 2013. In June 2016, Dr Sabrina Shah-Desai of Perfect Eyes Ltd carried out a tear trough filler procedure. The results were fine but did not eliminate the puffiness and so in August 2017 I had lower blepharoplasty surgery also carried out by Dr Shah-Desai. Following the surgery the under-eye puffiness I expected the surgery would resolve, became significantly more pronounced. Six months after the surgery, Dr Shah-Desai tried a device called Tixel to attempt to improve the result which only caused reddening of my skin, and twice injected an enzyme called Hyaluronidase in order to try and dissolve the under eye dermal filler, resulting only in a very short-term improvement. I was advised at that point by another oculoplastic surgeon not to attempt any other procedures and to allow it to settle.

The puffiness did not settle despite trying various creams and natural remedies,so in July 2020, on recommendation I made an appointment with Dr Daniel Ezra. My main concern was to find out whether the puffiness could be reduced by non-surgical means or by revisional surgery and also whether the other undesired results of the surgery, (which left me with some retraction of the lower eyelids, asymmetry of the outside corners of my eyes, with the right being higher than the left and a slightly lumpy appearance under my left eye) could be improved.

Dr Ezra has a very professional and calm, measured manner and explained that dermal filler, sometimes injected years earlier, could subsequently cause a reaction such as puffiness around the eyes. I told him Dr Shah-Desai had thought the same and twice injected Hyaluronidase with no success, but he explained he would use a cannula rather than a needle and the technique he used would have the effect of thoroughly ‘flushing’ the eye area with Hyaluronidase. Dr Ezra was completely frank about the likelihood of the procedure working, but emphasised the technique he used was generally much more effective and moreover was worthwhile trying before resorting to revisional surgery which can be risky and complex.

The results were fairly immediate, showing a marked improvement. Three weeks later, the puffiness remains significantly reduced and is barely noticeable. I would highly recommend anyone who has had under eye dermal filler and finds they are suffering from similar swelling/puffiness to make sure they have it thoroughly investigated by a specialist such as Dr Ezra to ascertain whether it might be driven by a reaction to dermal filler, which is apparently quite common, before considering having any surgery.

I am very grateful to have been recommended Dr Ezra and only wish I had been recommended to him several years earlier.