You stated in your question that 90 days ago, you had Juvederm to help you with the under
eye hollows and that you’re concerned that you have swelling, that you have some pigmentation
concerns and you are now clearly have lost some faith in your doctor’s ability to take
care of you properly and you’re asking for some additional opinions.
Well, I can certainly give you a little perspective based on the limited information I have here
with the two photos you submitted.
I’m a board certified cosmetic surgeon and fellowship trained oculofacial plastic and
reconstructive surgeon.
Helping people improve the appearance of their eyes is what I do every day in my practice
for over 20 years.
And certainly, the challenge is helping people strategize the best way to address what is
perceived as under eye hollows whether it’s with fillers or other options is something
we do a lot every day.
And dealing with situations like yours, people do come to us for some type of corrective
treatment.
That being said, I would go so far to say and to begin with is dealing with some of
the reactions that you’re dealing with and then we’ll deal with the under lying issue.
To begin with, the hyaluronic acid filler is often used to mask the appearance of puffy
under eye bags which is one of the things that I kind of see first is the puffiness
under the eyes which means that your doctor was trying to soften the transition.
Very often people interpret the hollow as being the valley next to the puffiness and
so they try to fill the valley when actually the puffiness is the mountain which probably,
strategically, is more effectively addressed first.
In our practice, if someone has a mild or a minimal amount of puffiness, we would do
something comparable to what your doctor did which is to try to soften the transition and
make the tear trough area look better and make the transition look nicer.
Now, that being said, understand that hyaluronic acid filler is a material that has something
that is hydrophilic tendency which means it absorbs water.
Sometimes in some people, that absorption of water can lead to some fluid accumulation
and that fluid accumulation can certainly be unsettling.
Usually that fluid just gets better with a little bit of time and absorption and it improves.
Nineteen days is unfortunately not too long for that fluid to occur.
What I have seen a lot is patients who have bags, when they’ve had the hyaluronic acid
filler placed, it actually makes their bags look worse.
And so, a lot of times, I do end up using hyaluronidase to actually dissolve the filler
altogether to just reveal what is actually the structure of the eye area.
As far as hyperpigmentation is concerned, this is one of the challenges of having darker
skin is that the skin can be very sensitive to any type of treatment including something
that’s meant to improve the ratio of volume in a way that’s supposed to be desirable.
A lot of times I would combine our strategies of using a filler such as Juvederm or usually
for under eye areas, I use Restylane and I combine that with platelet-rich plasma.
Platelet-rich plasma is derived from your own blood and it’s a concentration of the
wound healing factors, growth factors that would stimulate collagen and improve blood
supply and does seem to help pigmentation under the eyes and in a way may even mitigate
some of the issues that could happen with the reactive hyperpigmentation.
Unfortunately, with darker skin, reactive hyperpigmentation could last a while and it
might be something you can have to just manage conservatively in the short-term.
The other aspect of this is that if this was not the best procedure for you, it might require
either a different perspective of where to augment or to soften that appearance.
When I say augment, very often it’s good to augment the cheek area or the eyelid to
cheek junction in order to soften the transition.
A lot of times, when people have a very shallow cheekbone, when a doctor places this filler
in this narrow zone of the tear trough, it’s like they’re putting this material in a
shelf or in a ledge and there’s nothing under to support it and there’s no continuity.
Sometimes what we’ll do is we’ll augment the cheek bones in a method called a Y lift
approach where we’re actually placing it on the structure of the bone and it creates
this beautiful balance between the cheeks and the eyes.
In other times, when someone has significant puffiness, I simply tell them don’t do the
filler and I would rather strategize where we address the puffiness through a procedure
like transconjunctival blepharoplasty to address the underlying major cause and then deal with
volume correction after surgery.
So as you can see, there are many ways to approach these issues and there is a lot of
art to this.
I think it’s worth it to go and see your doctor again and give them the opportunity
to take corrective action.
You know, we routinely, in our practice, see our patients after 2 weeks of time after injectables
because there’s a lot of finesse to this.
It’s not always ideal when you do it in one point and get the optimal result.
Sometimes a little massage goes a long way, sometimes a little enhancement or adding a
little material but that’s something we do routinely in our practice after we do fillers
just to make sure things are okay because a little can go a long way when you do something
to balance or to deal with under correction.
So again, moving forward, see your doctor, discuss these issues with them.
Use your gut to see if you’re comfortable and confident.
If you don’t have confidence in your doctor, there’s nothing that they can do to make
you feel good about the result because you’ll keep second guessing them and at that point,
you should probably meet with other doctors and get additional opinions.
So I hope that was helpful, I wish you the best of luck and thank you for your question!