Thank you for your question.
You submitted your question with a photo. You describe in your question that you underwent
Juvederm injection under your eyes to help the appearance of under eye bags which appears
to have made the appearance worse. And further, you describe having 4 days worth of bruising
after the original injection such that you had to miss work. And it was suggested to
you by the doctor to undergo surgery because of the presence of under eye bags. And further,
you’re naturally questioning whether or not to do the injection or what to do moving
forward. You describe also that you developed an extra crease on your cheek.
Well, I can certainly share with you my guidance to patients who have had very similar experiences
who come to me from all over the world because of this new option for helping people with
under eye bags with injectable fillers. A little bit of background, I’m a Board-certified
cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have
been in practice in Manhattan and Long Island for over 20 years. Helping people with facial
appearance and the under eye area and the eye aesthetics has been a significant part
of my practice for this time. And certainly, I recognize as an expert the challenges that
many patients have when they seek different options to help their under eye area.
So to begin with, in situations like yours, I have more often than not seen a situation
where although it has been 6 months or even a year or longer from a point where a patient
had an injectable filler under the eyes that when they feel like their under eye bags have
worsened or they want to know what they need to do next, I find that it’s generally helpful
to first examine the patient. And if there is any question as to whether or not there’s
filler present, a lot of times it can be elucidated when a person is looking upward. And if it’s
fat, it’s often easy to tell because the fat pockets push forward. But that being said,
it’s very common for me to first just try to dissolve any residual filler that’s present.
It is not unusual for a hyaluronic acid filler to remain much longer and in fact kind of
settle in different tissue planes in a way that creates this baggy appearance. A lot
of times it is very helpful to then be able to do that then see what is truly the underlying
anatomy. A lot of times when people have under eye bags and they get fillers, those under
eye bags can become worsened. It’s about making the right choice for the right situation.
In my practice, if someone has mild puffiness under their eyes and in a scenario where they
don’t have time to have surgery, well we can certainly place filler in the tear trough
area to try to blend that natural contrast between the puffiness and the depression.
However, if someone has significant puffiness, well the definitive procedure is to do surgery
that is a procedure called transconjunctival blepharoplasty. This is a procedure that’s
routinely done in our practice through using local anesthesia with LITE™ sedation. It’s
done from the inside of the eye to address the puffiness.
And essentially, it may be in your situation that your issue has to be dealt with from
different angles. So I think there’s also an opportunity even though there’s a limited
view, I look at your eye and in the cheek area, I feel like there’s also probably
some opportunity for some volume enhancement in the cheek area probably to maximize the
appearance of the eyes. But I think that’s something that can be discussed later after
it’s clear what your true anatomy is. I think that one of the things that is critically
important is to have a really good global understanding of the aesthetics of your eye
and cheek area when you have a consultation. A lot of times people get in trouble because
if their cheek projection is relatively shallow, then placement of a filler in the tear trough
without any support in the cheek creates kind of a ledge without support and it ends up
kind of a crescent moon puffiness that ultimately results because there is no continuity.
So I think that although this is in the absence of a physical examination, it’s very important,
before you make a decision about whether or not do surgery is to determine what is truly
the cause of what you appear right now. The clue that speaks to me is that you describe
getting another crease in your cheek. That to me means that there’s volume. That volume
is either fat, it maybe a filler or a combination of both. And so it is in my opinion, generally
my practice, to first use hyaluronidase to dissolve any filler in this area and reveal
what is the true anatomy and then start from scratch.
So meet with your doctor who performed this. Discuss this with them. If you’re not sure
whether or not you are as comfortable and confident about this doctor then you can have
another consultation. Also to address the question about bruising
after under eye filler, certainly that is not an unusual story. In my practice when
I place under eye filler, I actually use something called blunt cannulas and I rarely get bruising
and it’s just a matter of technique and experience that I think helps every doctor
to do their procedure the way they feel most comfortable. And I would say that in the scenario
that you’re describing, it would not be surprising to me if the doctor has done injections
directly using a needle. And when you do it that way, you can sometimes disrupt some vessels
along the way. And if you do multiple injections which is very common, you can understand why
you had bruising. I would say that from that perspective, you have also some options so
you don’t have to think that doing filler under the eyes always means bruising. Certainly,
no physician is immune to having patients who are bruised but you work with probability.
And so in my practice, the use of blunt cannulas and creating this type of fill in this area
has worked out pretty successful in the way I approach it and that way, this bruising
is minimized. So I hope that was helpful, I wish you the
best of luck and thank you for your question.