Juvederm Under Eyes on Darker Skin

January 8, 2010

I am so sorry for your bad experience. I feel your pain and your frustration. I too have found that I have had to do a lot of research myself to work out what went so wrong with my face from various injectables. Despite my injector being a qualified doctor and having more than 20 years of experience, ALL of her strategies to resolve the issues that started more than 8 months ago have been incorrect and made things a million times worse. In fact, she could not have been more wrong if she had done it deliberately. I have come to realise that injectables are hit and miss regardless of how experienced the injector is. And when it comes to correcting errors, it is best to work it out for yourself. I am not a doctor. I am a lawyer. But because of the amount of mistakes my doctor made, I have taken the time to research as much as I can about injectables so that I can try to get my face fixed. In June 09, I had restylane in tear troughs dissolved with hyaluronidase. It was a disaster. See my review if you are considering dissolving your juvederm as it may just make it a whole lot worse. Hyaluronidase is not FDA approved to dissolve hyaluronic acid dermal fillers like juvederm and restylane. And it has only been used 'off label' for this purpose since 2006. Therefore, I do not think that any doctor can claim expertise in dissolving dermal filler with hyaluronidase. Further, I believe it damages natural tissue and some doctors agree with this. A lot of your skin is made up of natural hyaluronic acid and there are no relevant studies as to whether hyaluronidase damages your own collagen and hyaluronic acid as well as dissolving the filler. I think it does. This is something you should discuss with your doctor before deciding whether to dissolve the juvederm or wait it out. A couple of weeks after the hyaluronidase disaster in June 09 I had my tear troughs refilled with juvederm because there were marked indentations left in my skin along the orbital bone from the hyaluronidase. I now consider that it was way too early to have juvederm put back in. I still had swelling and trauma from the hyaluronidase. The tissue should have been given time to settle and the swelling to go away. The juvederm that was used to fill the indentations from the hyaluronidase is now two black lines. I don't think it is the tyndall effect because the juvederm is under the muscle along the orbital bone where it should be. However, the lines are definitely black and look worse in certain lights, so I really don't know what to think. I have also considered that it might be bruising (from trauma) that is taking a very long time to resolve or that it might be hemosiderin staining. It has been six months now and these black lines have not improved at all. They cannot be disguised with makeup either because they are too black. And to think all this started simply because I hated the dark circles under my eyes! They have never been worse. Irony. Concurrently with the restylane then hyaluronidase then juvederm disaster I had the biggest disaster of all - a botox disaster of monstrous proportions. Full facial drop (cheek ptosis) and festoon formation under my eyes, particularly the left eye. The facial drop was caused by botox (potentiated by antibiotics) administered in the bunny lines and crows feet areas. The festoon under my left eye was from a shot of botox directly under the eye lashes. I have photos that would put anyone off botox forever. I am also wondering if the facial drop has caused the darkening of the circles under my eyes. In some other reviews on RealSelf about botox-induced cheek ptosis and facial drop, the people report black circles under their eyes. So I have a dilemma and sadly I have to work it out myself because I have learned my lesson about doctors. Lots of it is guess work. When they tell you they have a solution you think it is because they have seen it before and they know it will work. Not so. I have been investigating V-beam laser for the black juvederm lines which will only work if it is long-term bruising or hemosiderin staining. If it is the tyndall effect then I am out of options as I will never let anyone put hyaluronidase in my face again. I agree with you that adverse outcomes from laser are more prevalent in people with darker skin, but laser is risky for fairer skinned people also, particularly around the eyes. I have waited six months to see if it will resolve itself and it hasn’t. I still really don't know what to do and I am terrified of making it worse but I can't live with two black eyes forever. Anyway, I note that you describe your cheeks as 'lower' and you attribute it to the juvederm put in your cheeks. Did you also have botox in the crows feet area? This might be causing the lowered cheeks. I have written all over this site about botox induced cheek-ptosis. I don’t know if you had botox or not, but if you did then this might be something for you to consider in the whole scheme of things. When something goes wrong it is sometimes hard to work out what exactly happened if more than one procedure has been done concurrently, as in my case. And it is easy to focus on the most obvious problem, which in your case is the discolouration. Let us know what you find out as this website was great for me for information so as to work out what had happened to me. Further, it gives you real stories of good results and adverse outcomes from the perspective of people who have actually undergone the procedures, not just statistical data. I have also subscribed to numerous medical journals and together with the stories on this site, I finally worked out what had happened to me. It hasn’t helped me fix it yet (and only time will fix botox) but it at least armed me with the knowledge to ask the right questions to the doctors. I see you have done the same. Please let us know what you decide to do about the juvederm discolouration so you too can contribute to the valuable resource that is Real Self. I wish you all the best and a speedy recovery. Cheers.

January 31, 2010

Can you post pictures of this? What is your age?

February 2, 2010

Hi Kristal - I turned 37 late last year. I have hundreds of photos of my botox horror over the past 30 weeks but there is no way to post them on RealSelf without showing who I am. As a person who values privacy (I am not even on FaceBook) I just can't do that. Sorry.

January 8, 2010

And I should also mention that although I have light skin, it is prone to melasma. The hyaluronidase to dissolve the restylane was injected into the tear troughs under my eyes and some of it went down my cheeks (on the inside) and it brought a whole lot of melanin and hemosiderin to the surface on my cheeks just underneath where it was injected. This staining is also still there more than six months later. It is on the top of my cheeks directly under the tear troughs. As you have darker skin, this could possibly happen to you too and I thought this might be a relevant piece of information for you in your decision about dissolving the filler or waiting it out. I am looking at the V-beam laser to try to remove this staining, but laser might not be an option for you if hyaluronidase causes the same reaction for you. You might be stuck with it. Again, my best wishes to you. Cheers

January 8, 2010

Hi, I am so sorry about what is happening to you. I feel the same way. My experience is fairly recent, but it is very painful for me to look at pictures of myself from just one month ago. I keep thinking, "what was I so upset about?" To answer your question, I did not have any other filler or injections prior to this. This was my first...and if I ever get this rectified, my last. I will just wait until research develops something far less invasive. Thank you so much for letting me know about the hyluronidase. I did not know this, and unfortunately, I did have some already. Very little. I don't know that it impacted the discoloration -no better or worse. I don't know that it really changed the shaping of the juvederm either, a little perhaps...I had been doing reading about this, and it does seem like doctors are divided on the topic of whether it dissolves your own HA or not. I have also read that some people are allergic to hyluronidase, and that people should have skin tested prior to usage (my dr did not do this), and I read this afterwards, of course. Right now, I am not doing anything further to my skin that could cause any further trauma. I am just seeking out 2nd, 3rd...opinions, just to know my options and prepare for worst case scenarios. Yesterday, I had a second opinion with a facial plastic surgeon. He felt that this might be just prolonged bruising since my injections are just shy of 2-3 weeks ago. It is difficult to tell at this point. I did have a long-distance consulation with a center in LA, that specializes in lasers and I am also going to consult with another here locally (in DC). They seemed to believe that it is also prolonged bruising at this point, but if it is permanent hemosiderin staining that a pulsed-dye laser would be best for this situation and my skin type. You seem to have done a great deal of research. I am on the starting end of all of this, and am a professional myself (Clinical psychologist), so can understand how detrimental this must be. Thank you again and good luck to you as well.

February 9, 2010

Hi, Just as an update, I have not done anything yet about the discoration except seek out a lot of opinions, heat, and some good antioxidatant creams. It's faded -though very little. I do think the vitrase has damaged some of my natural HA, and there might be some staining from that as well. It's so hard to tell, with so many possible reactions going on. I wanted to ask you, tried but failed if your discoloration had changed at all over the past 6 months? Thanks.

February 12, 2010

Hi virginia402 - unfortunately, I don't have anything good to report. I still have the discolouration more than 7 months later and it has not really changed at all. I am still too scared to try laser (fear of another disaster) and I have tried topical creams (antioxidant, alphahydroxy, hydroquinone, meladerm etc etc) but they either don't work or they irritate my skin terribly and make the discoloured areas very red. I have a question for you too. Is the texture of your skin different in the discoloured areas? Mine is. It is crepier and looks older than the rest of my skin. It also looks slightly depressed. Not an actual indent but the area is just flattened out a bit. Is this your experience also? I am wondering if this too is evidence of damage to my natural hyaluronic acid from the hyaluronidase. As I have said, I am terrified of laser because I simply could not bear another disaster but I really feel that I need to do something as the discolouration really is horrible and is not going to go away on its own. If I get the courage up to do V-Beam or similar then I will post my results on RealSelf. You said that you have sought several opinions. What are your options? Have any of the doctors had anything helpful to suggest? To be honest I am pretty down at the moment. I got my 'before' picture from my doctor in the post the day before yesterday and I am devastated by my own stupidity. I looked so much better before. Again, I wish you luck and let us know how you progress. Cheers

February 12, 2010

Please do not do laser. from your experiences, it seems your skin is too sensitive to deal with that. I wish I had not done fraxel. Please do not do that. It is extremely expensive and disappointing. It also left me with indentations in my cheeks that were not there before.

February 14, 2010

Hi Krystal - Thanks for your concern and your advice. I have replied below. K

February 15, 2010

Hi, I'm sorry I didn't reply sooner. The texture might be somewhat different, but not too much, and it's not very noticable...at least not yet. I think this is actually due to the juvederm, where the Dr. tried to get me more bang for my buck and massage it through my cheek. That's actually where it looks the worse, not the where he put the hyluronidase. I can't really see that. He used very litte on me. And I'm still waiting for a lot of the juvederm to dissapate. I've been using A LOT of vitamin C creame (kinerase) coffeeberry, and my normal night cream, which is regenerist. And I also use eye illuminator by skin medica. All of this actually makes my skin, except for the eye area look pretty good...Most people think that the eye area is my natural discoloration, except that I didn't have any "natural discoloration" prior to this experience. At this point I might just have to live with that.

February 16, 2010

Thanks for your reply, virginia. Fingers crossed for you that the discolouration goes away with the juvederm! Let us know if it does. Cheers, K

February 18, 2010

Hi, Thanks...I hope so too. I really wish you the best as well. I wanted to note that I have sought out several opinions (you had asked about this before). I'm sorry, sometimes I read through this at work, and am not always able to reply fully. I went to an oculoplastic surgeon/ ophthamologist, another dermatologist and two facial plastic surgeons. I also sent pictures to two facial plastic surgeons via web who specialize in tear trough and one who is of Indian descent, who may understand more about ethnic skin. Here's what I found out: 1. Most if ALL said it was most likely prolonged bruising and or a hemosiderin stain (some argue this is the same thing. And on ethnic skin, this could last for months because of the increase in melanin that injury can cause. Almost all said that it will go away, but it will be LONG. 2. Almost ALL said to do nothing more and to just wait it out. One said that it might be helpful to do warm wet compresses, to improve circulation to the face. I have to admit this did help some. But not too hot, because you don't want to injure or burn the skin. I think waiting is the hardest thing to do. I hate looking at myself in the mirror. I hate looking at old pictures of myself. I hate looking at fashion magazines and I can't even bear to go out on a date anymore because I'm so self conscious. It's just work and home... I hope that the above helps. Just wanted to post all the info. I found, and thanks much for all of yours too! Virginia

February 21, 2010

Hi V - just work and home for me too. All old photos are packed away because it is just too depressing to see them, I avoid the mirror if possible and my level of self-consciousness means I don't socialise anymore either. A somewhat ironic outcome for both of us from procedures that are supposed to enhance self-confidence! In respect of hemosiderin staining, did anyone give you an idea of how long it would take to resolve on its own? I have waited 9 months and mine is no better. That would seem a long time? Waiting is super hard, I agree! There have been several times when I am so tempted to try to do something about it but the fear of making it worse stops me. This is probably a good thing. I will let you know if it improves and I would greatly appreciate it if you could do the same. Cheers, K

February 25, 2010

Hi K, w/r/t to hemosiderin staining, I got different lengths of time, although none as much as 9 months. I'm so sorry. Most said I would need to wait at least a month to more like 2-3 months. And 1 said that if it was not hemosiderin staining and maybe a combination of staining and tyndall, that I would need to wait until the juvederm was fully out of my face, which could take up to a year. My fear is that it might take that long, to be honest. I also think that the juvederm just highlights what was somewhat naturally there (I mean some, very slight, natural discoloration). I actually looked better with a little bit of hollow, is what I mean to say. And as the juvederm recedes, which it is slowly...I start looking more and more like my old self...which I have never appreciated more. That is the one positive from all this. Goodluck K and stay patient!

February 27, 2010

Hi V - Thanks for your words of encouragement. I am happy to hear that you are doing better! I am using the 'year rule' for my poor face as in leave it all alone for a year! This fiasco has certainly taught me patience. I suspect by now that the staining is not going to go away and topicals have done all they can. Nine months would seem to suggest is is permanent and maybe only laser will get rid of it. Still too scared for laser at this point but I have looked like rubbish for more than 9 months now, so what's another few months to wait it out just to be sure? Ha! I am thinking of taking a month off work in July for blepharoplasty (to fix botox damage under eyes) and laser (to fix staining) but I am not committed to anything and just investigating options. Plus I still have the fear of trusting another doctor to get over! Thanks again for your reply. K

February 2, 2010

This is something imperative I want everyone to take with them before having any sort of elective procedure: Doctors are people. They do not know everything. As a matter of fact, they do not know as much as they would like you to let on. All you need is a 70% to pass and get your MD. Then after that, you can pass your boards with less-than-perfect scores. I have been to physicians for other reasons, and they would disagree with each other of what my condition was. As for vitrase, some say it does dissolve natural HA, some say it does not. From my own experience, it does. Hyaluronidase was specifically meant to permeate your native tissues long before it was used off-label to dissolve doctor's mistakes with Juve and Resty. Many doctors in the USA can also be very greedy. They will push to inject you with a tube of Juve because they know they can get several hundred dollars profit from each tube. They can do several patients within one hour and leave them scarred for life. What recourse do we have? I too looked at a picture of myself before I had Juve. It was a pic that was taken one week before, and my bf was telling me what goddess I am. I look so beautiful in that picture. My eyes were so beautiful did not bag up everytime I smile, like they did afterwards. To this day (2 years later) I still have resididual Juve bulges when I smile, so i try to smile very softly so that no one sees them. I got the Juve to look smoother and youthful, but came out looking older and sick with the bags and ridges. I was going to surprise my bf since I wasn't seeing him for 2 weeks, and he was horrified and asked what have I been doing to make myself look so sick. I was very depressed for months, then did some vitrase, did a few back-and-forth cycles because too much vitrase was added, yada yada, and my eyes still show of the battle I have been through. I think if every doctor were competent and caring and not greedy, these websites would be few and far between.

February 4, 2010

Krystal - I could not agree with you more.

February 14, 2010

Hi Krystal - thanks for your advice. I agree that my face has gone through hell and I am being very cautious in my approach to removing the discolouration. What happened with your fraxel experience? I have been looking at the reviews of laser on here and can see that lots of people are initially happy with fraxel then they encounter long term problems like fat loss from the burns - for example the late Angie Walker (Awalk on RealSelf). Is this what happened to you when you say you got indentations in your cheeks? Was it from the burns? Are these areas discoloured also? From what I can gather there are two types of laser - ABLATIVE (Erbium, CO2, Fraxel, TotalFX etc) and NON-ABLATIVE (KTP, Gemini, Medlite, Pulsed Dye, V-beam, Ruby, Nd:YAG etc). The whole laser caper is massively confusing, for example YAG can be ablative (Erbium YAG) as well as non-ablative (Nd:YAG). Lots of people refer just to 'YAG laser' in the reviews and I always wonder which one they are talking about. Add to this the various manufacturers' names for the lasers and it just about does your head in trying to work it all out. At least I am doing my research in advance for once! I am planning to go to the Victorian Cosmetic Institute and they have a very good summary of all the lasers at: http://www.thevictoriancosmeticinstitute.com.au/laser-general-information/ The Victorian Cosmetic Institute is not in my home town but I am prepared to travel for a consultation because they have ALL the lasers and their website looks like they know what they are doing. From my reading of the reviews on RealSelf about ablative lasers, it would appear that lots of problems occur because they are designed to resurface the skin and they are therefore attracted to the water in the skin. From the reviews, I can see huge down time, burns, fat loss, more discolouration, results that just don't last and permanent damage. I would be way, way too afraid to ever try any ablative laser. I am looking at non-ablative lasers only and I have a variety of issues that I think would need to be treated by a variety of lasers. I can see from the information on the Victorian Cosmetic Institute website that some non-ablative lasers are attracted to melanin (brown pigment) and some are attracted to oxyhaemoglobin (blood) and some are attracted to both. I think I need a combination of lasers to treat my post-juvederm, post-hyaluronidase, post-botox skin issues because some of my problems are blood-related and some are pigment-related. Further, I think some of my pigmentation problems are dermal and some are epidermal. In respect of the new wrinkles and crepey skin, I would rather live with it than try an ablative laser. Treating the discolouration will be enough for me. I would like to have a Woods lamp assessment and get some proper advice about which combination of non-ablative lasers might actually work. I have also considered a chemical peel, but I think the hemosiderin and melanin staining is too deep to be touched by a peel. Lots of disaster stories about peels too! I have a very demanding job and it is going to be a real effort in co-ordination to fly back and forth from where I live to Melbourne for this treatment and it will be expensive too. But I have been hiding at home for more than 7 months and I desperately need to feel positive about something, so I am looking at 2010 as the year to get my face back. I have also resigned myself to a lower blepharoplasty in July this year to fix the botox damage under my eyes. I have deliberately not sought out a surgeon yet because I don’t want to rush into anything. I know from the feel of my face and the weakness of my facial muscles that it is still way too soon. My dilemma is should I address the discolouration before the surgery or have the surgery and then address the discolouration? I am really not sure what to do. Do you have any experience with non-ablative lasers, Krystal? Any thoughts about whether it should be laser then surgery or surgery then laser? Or do you think I should avoid laser altogether, even the non-ablative kind? I have had non-ablative laser before to treat a broken vein under my nose and it was successful. It scabbed up for a couple of days but then went away. Unfortunately, it also came back a couple of months later! There is so much trial and error with these procedures, but I am tired of being the error... Thanks again for your advice Krystal. I will certainly consider everything you have said and I would appreciate any further advice you have. Cheers, K

February 18, 2010

Hi TBF! :) yes i wish you did live nearby and we could have coffee or something. For my own opinion about what you should do... well i am not medical professional (and from what I and others have experienced, i would be cautious even from medical professional opinions), it would be great to look at you first, but from what you describe, I would go for the bleph first. But finding a good dr is imperative. You are right not to rush into anything. Look at before and after pics. Do not let anybody push you into anything. (I once visited a PS who wanted to carve up my face in my 30's. He wanted to do upper and lower bleph and also cut into my hairline to do a brow lift! It was crazy! i refused, of course.) Yes I do have experience with non-ablative Fraxl, which I would not recommend. It is extremely expensive, and from my own experience, damaging. I have what you describe, where I guess the girl went over my dark spots too many times, or maybe the laser is just attracted to melanin like you state, but I have indentations where the dark spots are... and the dark spots are still there! There are more things I would like to do, but like you, I am waiting. A lot of these horror stories on here are from people who rushed into a procedure trusting a practitioner. So lately I have been doing chemical peels and using tretinoin and Avon products and staying away from doctors. :)