Using cosmetic fillers to treat eye bags and under eye hollowing have grown in popularity over the past several years. Many people are unaware that fillers can be placed by doctors, non-physicians like nurses, or aestheticians, and physicians with no surgical experience. The safety of the fillers, the willingness of the manufacturers to sell more products, along with local state laws allow fillers to be used without any standardization or oversight.
A major problem is that fillers are not always the best treatment option. 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, which has resulted in the appearance of eye bags, lumps, and irregularities, or even larger eye bags than they had before cosmetic treatment. Fortunately, hyaluronic acid fillers are reversible, and results can be corrected and managed.
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 like eyelid ptosis, and lacrimal system surgeries. As an eyelid specialist, I also perform revision work for eyelid surgeries originally performed by other doctors, for patients who come to us from all over the world.
I am 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 originally had done elsewhere, by dissolving their original filler and starting from scratch, and in some patients who had semi-permanent fillers, surgically removing them before applying a filler with fewer risks.
Dermal fillers are effective for slight cases of under eye bags, as well as under eye hollowing. Filler is placed in the tear trough below the eye bags to blend with the forward projection, making the eye 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 bags. However, if the eye bags are too prominent, and filler is added to blend them, too much volume from the filler can exceed a natural-looking contour of the under eye area, so the under-eye area looks puffier 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 fat that causes more prominent eye bags. Unfortunately, if a doctor, nurse, or other practitioner who 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.
How to Dissolve Under Eye Filler
When someone is dissatisfied with hyaluronic acid fillers done elsewhere, I often use hyaluronidase to dissolve the filler and determine what is the true anatomy. Once I see the true facial anatomy, I make recommendations regarding placement of filler, surgical correction, or a combination of the two.
There are times when someone had filler placed under the eyes several years prior and expected the filler to disappear. Oftentimes, these patients look swollen and feel like they don’t look like themselves. Generally, fillers placed in this area are metabolized over 4 to 12 months. If the filler is still present after 12 months, this may be due to 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 in the right tissue levels to dissolve the filler.