Should Juvederm be placed under the tear trough groove? Or in the groove?
The photo on top illustrates the before placement of Juvederm. The bottom picture is after (1day)
what could be done to get a smoother result?
Thank you for your question!
You submitted two photos: a before and after you went under Juvederm injections under the
eyes and you’re asking a question about achieving a smoother result. Well, I can certainly
help you with some perspective from my practice.
I’m a board certified cosmetic surgeon and a cosmetic oculofacial plastic surgeon practicing
in Manhattan and Long Island for over 20 years and under eye aesthetics be it puffiness,
hollowing, or both is something we deal with in our practice every day. So I can certainly
give you my perspective when it comes to the use of fillers to help people who have under
eye hollows and puffiness.
The first photo, it is clear that you have lower eyelid fat prolapse. Now of course,
you are probably made familiar with the fact that fat around the eyes bulge forward and
it is always has been the standard of care that you address this issue surgically. One
the hyaluronic acid fillers came out, there was some room to soften that appearance and
certainly, it is something we do in our practice.
I would ask you to take a step back and look at the aesthetics of how you appear after
the procedure. You see, when we see patients, we often see patients who have had hyaluronic
acid placed under their eyes and when the fat pockets are beyond a certain threshold,
then very often, the amount of filler placed eventually makes the under eye area look very
puffy. And the appearance right now with the photo, of course, being one day afterwards,
makes me see when I see this photo, I see two areas of puffiness and although that tear
trough area has improved, the question you should ask yourself when you look at yourself
is, is this the look that I want?
When we do fillers in our practice for issues like this, we have our patients come back
for the evaluation about two weeks. And the reason is as follows: one is when the injectable
is placed, there is a certain amount of swelling that is in response to the actual trauma of
placing in the skin even when done very delicately. Two, is that the material is placed but it
isn’t fully settled or integrated into the tissue. So we allow two weeks to allow that
process to occur. Hyaluronic acid also absorbs water and so, there’s a certain amount of
fluid that can affect the final result.
Now, it has been my philosophy and although I don’t have a side view photo of you, it
has been my philosophy that the fat pockets are beyond a certain level, even when there’s
relative under eye hollowing manifested by volume loss in the tear trough, in the eyelid-cheek
junction and the malar or submalar areas then we need to have strategy. And in general,
if the puffiness is beyond a certain threshold, we can’t add enough filler to make it look
good because the fat’s already pushed so forward that adding volume means making the
tear trough area elevate but also having to make the cheek elevated.
There have been numerous patients in our practice who have come to us who we use hyaluronidase
to actually dissolve the material because their eyes became kind of lost with all of
this material. I’m not saying that that’s the situation for you. For your aesthetics,
this might be desirable.
When I counsel patients about this, I usually say let’s address the negatives which is
the puffiness and that’s addressed surgically. Now many people are scared of surgery but
when they finally learn about the way we do our surgery, it’s lets daunting. We do our
procedures under local anesthesia with LITE™ intravenous sedation in our own office operating
facility. So it’s not like going to a hospital, it’s not like going under general anesthesia.
So in so many ways, it actually compares similarly to having filler injections and we definitely
address lower eyelid fat pockets. In a younger person, we do the procedure called transconjunctival
blepharoplasty which means that there’s not external incision and we get very nice
results that way.
Now I also counsel patients that if they need volume correction, well it’s so much more
effective when you address the fat prolapse and you can be strategic about placement of
filler in the tear trough, the eyelid cheek junction and in the submalar area.
So I think that communicating with your doctor about your concern and probably wait to allow
to settle before you add more filler and of course explore the option of having lower
eyelid blepharoplasty. I think that if you’ve been trying to get injectables to avoid surgery,
you’ll find that in the right hand, in the right situation, the surgery can be not so
scary as you might have initially though. But many of our patients who have come to
us who fear about lower eyelid surgery have said to me that “If I knew it was that easy,
I would have done it sooner.”
So meet with your doctor again. I think one day is a little bit too early to make a judgement
and a recommendation but at least, I hope I was able to help you with a perspective
on how deal with what is primarily a lower eyelid fat prolapse issue.
So I hope that was helpful, I wish you the best of luck and thank you for your question!