Juvederm is Effective for Under Eye Hollowing and Slight Eye Bags, but Can’t Treat Larger Eye Bags

Should Juvederm be placed under the tear trough
groove? Or in the groove? The photo on top illustrates the before placement
of Juvederm. The bottom picture is after (1day) what could be done to get a smoother result? Thank you for your question! You submitted two photos: a before and after
you went under Juvederm injections under the eyes and you’re asking a question about
achieving a smoother result. Well, I can certainly help you with some perspective from my practice. I’m a board certified cosmetic surgeon and
a cosmetic oculofacial plastic surgeon practicing in Manhattan and Long Island for over 20 years
and under eye aesthetics be it puffiness, hollowing, or both is something we deal with
in our practice every day. So I can certainly give you my perspective when it comes to the
use of fillers to help people who have under eye hollows and puffiness. The first photo, it is clear that you have
lower eyelid fat prolapse. Now of course, you are probably made familiar with the fact
that fat around the eyes bulge forward and it is always has been the standard of care
that you address this issue surgically. One the hyaluronic acid fillers came out, there
was some room to soften that appearance and certainly, it is something we do in our practice. I would ask you to take a step back and look
at the aesthetics of how you appear after the procedure. You see, when we see patients,
we often see patients who have had hyaluronic acid placed under their eyes and when the
fat pockets are beyond a certain threshold, then very often, the amount of filler placed
eventually makes the under eye area look very puffy. And the appearance right now with the
photo, of course, being one day afterwards, makes me see when I see this photo, I see
two areas of puffiness and although that tear trough area has improved, the question you
should ask yourself when you look at yourself is, is this the look that I want? When we do fillers in our practice for issues
like this, we have our patients come back for the evaluation about two weeks. And the
reason is as follows: one is when the injectable is placed, there is a certain amount of swelling
that is in response to the actual trauma of placing in the skin even when done very delicately.
Two, is that the material is placed but it isn’t fully settled or integrated into the
tissue. So we allow two weeks to allow that process to occur. Hyaluronic acid also absorbs
water and so, there’s a certain amount of fluid that can affect the final result. Now, it has been my philosophy and although
I don’t have a side view photo of you, it has been my philosophy that the fat pockets
are beyond a certain level, even when there’s relative under eye hollowing manifested by
volume loss in the tear trough, in the eyelid-cheek junction and the malar or submalar areas then
we need to have strategy. And in general, if the puffiness is beyond a certain threshold,
we can’t add enough filler to make it look good because the fat’s already pushed so
forward that adding volume means making the tear trough area elevate but also having to
make the cheek elevated. There have been numerous patients in our practice
who have come to us who we use hyaluronidase to actually dissolve the material because
their eyes became kind of lost with all of this material. I’m not saying that that’s
the situation for you. For your aesthetics, this might be desirable. When I counsel patients about this, I usually
say let’s address the negatives which is the puffiness and that’s addressed surgically.
Now many people are scared of surgery but when they finally learn about the way we do
our surgery, it’s lets daunting. We do our procedures under local anesthesia with LITE™
intravenous sedation in our own office operating facility. So it’s not like going to a hospital,
it’s not like going under general anesthesia. So in so many ways, it actually compares similarly
to having filler injections and we definitely address lower eyelid fat pockets. In a younger
person, we do the procedure called transconjunctival blepharoplasty which means that there’s
not external incision and we get very nice results that way. Now I also counsel patients that if they need
volume correction, well it’s so much more effective when you address the fat prolapse
and you can be strategic about placement of filler in the tear trough, the eyelid cheek
junction and in the submalar area. So I think that communicating with your doctor
about your concern and probably wait to allow to settle before you add more filler and of
course explore the option of having lower eyelid blepharoplasty. I think that if you’ve
been trying to get injectables to avoid surgery, you’ll find that in the right hand, in the
right situation, the surgery can be not so scary as you might have initially though.
But many of our patients who have come to us who fear about lower eyelid surgery have
said to me that “If I knew it was that easy, I would have done it sooner.” So meet with your doctor again. I think one
day is a little bit too early to make a judgement and a recommendation but at least, I hope
I was able to help you with a perspective on how deal with what is primarily a lower
eyelid fat prolapse issue. So I hope that was helpful, I wish you the
best of luck and thank you for your question!

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