Bags under the eyes after filler – immediately and after months/years???

Hi Dr. Irwin, I had Juvederm under my eyes 4 years ago at a med spa by a supposed RN "expert" who had been on "Good Day America", etc...I should have known better! The injections ended up causing huge bags. A year later my new dermatologist in a different city recommended gentle massage and that helped them go away but now, a full 4 years later, I have one area under one eye where there is a big weird loose bag when I smile. I am so upset. I went to one good facial plastic surgeon who told me that the injections had been too close to the skin and I had a "sausage" left over and there was probably still some product in there (4 years later?) He recommended CO2 FX to get rid of the bag and "maybe dissolve the remaining product with the heat". I know the CO2 FX is very aggressive. Does this sound right and are there any less aggressive (Fraxel?) other remedies?

I’m glad you asked this because I’m hearing from many of you about problems with the under eye area.  More on eye area issues here.

While it’s common to have some swelling for a week or two after a filler injection under the eyes, it’s not the result anyone wants if it lasts  longer than that.  Only experts should be injecting in this area and it’s off-label for the below.   So here are some thoughts:

  • Juvederm tends to swell less immediately but tends to fluctuate more from morning to night (not optimal – stability is good) and may swell more in the long term.  It’s more hydrophilic (means attracts water) than Restylane, Belotero or Voluma.
  • Restylane often swells more in the first week, but less later;
  • Belotero is more painful and swells less short term, but experience is showing it may swell more as months go by;
  • Sculptra, Perlane, Juvederm Ultra Plus, Radiesse, silicone or Artefill should not, in my opinion, be used in this area
  • Placement of the under eye filler can cause temporary congestion of the lymphatics.  Gentle massage will usually fix that.
  • It’s unlikely that Juvederm is still present 4 years later, but I never say never.  A small of amount of hyaluronidase injected into that area will start to shrink it, if it’s still there.

In general, when there’s still a pouch much later, the skin may have stretched during the original problem.   It’s true that CO Fx may help to tighten that skin but it should be done, in my opinion, gradually over 2-3 treatments.   Please get a second opinion from a board certified dermatologist and then compare the recommendations.

I hope this helps,  Dr. I

Dr. Brandith Irwin, MD

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