[Music][Music]my eyes look worse after under-eye
filler what do I do? Using cosmetic
fillers to treat eye bags and under-eye
hollowing has grown in popularity over
the past several years many people are
unaware that fillers can be placed by
physicians and non-physicians with no
surgical experience the safety of the
fillers and the willingness of the
manufacturers to sell more product along
with local state laws allow fillers to
be used without any standardization or
oversight the problem is that fillers
are not always the treatment of choice
in many situations overlooking the
factors which determine who is a better
candidate for filler placement has led
to many people having too much filler
placed under their eyes this resulted in
the appearance of eye bags lumps and
irregularities or even larger eye bags
than they had before treatment
fortunately hyaluronic acid fillers are
reversible and results can be corrected
and managed i’m dr. Amiya Prasad I’m a
board-certified cosmetic surgeon and
fellowship trained oculofacial plastic
and reconstructive surgeon I’ve been in
practice in Manhattan and Long Island
for over 20 years I’m well known for my
work with upper and lower eyelid surgery
including surgeries for hooded upper
eyelids lower eye bags double eyelid
surgery and oculoplastic specialty
procedures such as ptosis and lacrimal
gland and system surgeries as an eyelid
specialist I also perform revision work
for eyelid surgeries originally
performed by other doctors and these
patients come to us from all over the
world I’m also known for my work with
facial fillers in areas such as the
cheeks jawline lips chin forehead as
well as both the upper and lower eyelids
I also help patients with reapplication
of fillers they’ve had done elsewhere
this is done by dissolving the original
filler and starting from scratch and in
some patients who have had
semi-permanent fillers actually
surgically removing them before applying
a filler with lower risk cosmetic
fillers are effective for slight cases
of under-eye bags as well as under-eye
Halloween filler is placed in the tear
trough below the eye bags to blend with
the forward projection of the puffy
under eye bag making the bags look less
puffy this works well with eye bags that
are not too prominent as the filler can
create a more consistent contour under
the eyes and camouflage the presence of
the bags however if the eye bags are too
prominent and the filler is added to
blend it too much volume from the filler
can exceed a natural-looking contour of
the under eye area so the under eye area
looks more puffy than before the filler
was placed an experienced eyelid surgeon
who also performs under eye fillers
knows where to draw the line between
using filler to camouflage slight eye
bags and when surgery is needed to
reduce and sculpt the fact that causes
the more prominent ibex unfortunately if
a doctor nurse or other practitioner
cannot perform surgery in cases of
larger eye bags they may insist on using
filler to treat this area themselves
rather than referring their patient to a
surgeon when someone is dissatisfied
with hyaluronic acid fillers done
elsewhere I often use hyaluronidase an
enzyme to dissolve the filler and
determine what is the true underlying
Anatomy once I see the true Anatomy I
make recommendations regarding placement
of filler surgical correction or a
combination of the two
our times when someone had filler placed
under the eyes several years prior and
expected the filler to disappear often
time these patients look swollen and
feel that they don’t quite look like
themselves generally fillers placed in
this area are metabolized over the
course of four to twelve months if
filler is still present after 12 months
this may be due to something called
encapsulation encapsulation is when the
body forms a barrier around the filler
which prevents it from being metabolized
naturally in situations like this the
enzyme hyaluronidase can be placed at
the right tissue levels to dissolve the
filler results from hyaluronidase can
often be seen immediately however some
fluid and swelling may take some time to
diminish many times I’ve seen patients
whose doctors attempted to dissolve
their filler several times without
success this is where surgical
experience with deeper anatomy allows me
to place hyaluronidase more precisely to
reveal the patient’s true anatomy I
usually tell my patients to come back
after a week or two to assess if any
residual filler may be present and if
additional dissolution is needed my
patients routinely go back to work the
same day or the next day so what if
dissolving of the under-eye filler
reveals prominent under eye bags and
surgery is the appropriate solution I’ve
developed a strategy to perform surgery
in a way which provides my patients with
the natural appearance with quicker
recovery and minimal downtime it comes
down to surgical technique medical staff
coordination type of anesthesia and
aftercare in my practice I routinely
perform under eye bags surgery in my
office operating facilities certified by
the Joint Commission with local
anesthesia and light intravenous or IV
sedation I perform a procedure called
conjunctiva blepharoplasty which allows
me to address the fat pockets from the
inside of the eyelids which though
technically more complex is actually
less traumatic and disruptive to the eye
anatomy this preserves the true shape
that most people want to maintain
essentially my patients are able to go
back to work in one week with minimal
swelling or bruising in fact many
patients who come to us to address their
dissatisfaction with fillers have
recounted how they had swelling and
bruising four weeks after filler
placement they are often impressed on
how my performing surgery resulted in
less swelling and bruising than when
they had filler injection many times my
patients who come in for removal of
filler are doing so because they have an
important event coming up whether I
place filler or perform surgery I would
recommend at least two weeks of lead
time to allow for settling and stability
the growing popularity of non-invasive
procedures creates a perception that
these solutions are just as good as
surgery this is of course not true but
these procedures do have a place as a
surgeon I’ve integrated many minimally
invasive procedures in my practice
including injectables micro needling
lasers and radiofrequency technology to
provide my patients with comprehensive
strategies and solutions particularly in
areas where surgery is not enough for a
patient full needs it’s important to
recognize that any procedure where the
skin is being medically altered or a
needle is being placed through the skin
is an invasive procedure I routinely
place fillers for patients who have
minimal fat prolapse with under-eye
Halloween I also will not perform
injectables when surgery is the more
appropriate solution your option if
under-eye filler makes your eyes look
is to first dissolve the filler to
restore your pre filler anatomy once
that is done you can determine what is
appropriate in your situation now
knowing that both injectable placement
and surgery can have comparable risk and
recovery I hope you found this
information helpful thank you for your