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Under Eye Fillers Gone Wrong. What to Do?

[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
worse
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
question
[Music][Music][Music][Music]

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.

under eye fillers gone wrong photo

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.

dissolving filler under eyes before and after
dissolving filler under eyes before and after

How Quickly Does Hyaluronidase Work?

Results from hyaluronidase can often be seen immediately, however, some fluid and swelling can take 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.
swelling after under eye filler fixed by Dr Prasad before and after
under eye filler gone wrong fix by Dr Prasad

What If dissolving the filler reveals prominent under eye bags, with surgery being the appropriate solution? I have developed a strategy to perform surgery in a way that provides my patients with a natural appearance, with quicker recovery, and minimal downtime, which comes down to surgical technique, medical staff coordination, type of anesthesia, and aftercare. In my practice, I routinely perform under eye bag surgery in my state-of-the art operating facilities with local anesthesia with LITE IV sedation. I perform a procedure called transconjunctival blepharoplasty, which allows me to address the fat pockets from the inside of the eyelid, which though technically more complex, is less traumatic and disruptive to the eye anatomy, so it preserves the true shape that most people want to maintain.

Essentially, my patients can go back to work in 1 week with minimal swelling or bruising. Many patients who’ve come to us to address their dissatisfaction with fillers have recounted how they had swelling and bruising for weeks after filler placement. They are often impressed with how my performing surgery resulted in less swelling and bruising than when they had filler injections.

one week lower blepharoplasty recovery photo
under eye bag surgery recovery after 1 week
Many times, 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 2 weeks of lead time to allow for settling and stability.

What is the Best Solution for Under Eye Problems?

The growing popularity of non-invasive procedures creates a perception that these solutions are just as good as surgery. While this is not true, non-surgical procedures do have a place. As a surgeon, I’ve integrated many minimally invasive procedures in my practice including injectables, microneedling, lasers, and radiofrequency technology to provide my patients with comprehensive strategies and solutions, particularly in areas where surgery is not enough for a patient’s 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 hollowing. I also will not perform injectables when surgery is the more appropriate solution. Your option if under eye filler makes your eyes look worse 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.

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