Tear Trough / Under Eye Treatment with Juvederm

Hello, Dr. Rivkin.

I had Juvey Ultra done yesterday in several places on my face, one syringe total. I had one NL fold done (other was still holding up from previous filler injection) and the orbital area of both eyes (not really TT area) and one lower cheek area where I had some focal fat loss (ugly blue bruise there now).

I have what this doctor said is mild malar/festoons (ugly name isn't it?) under one eye in particular. He said no surgery would fix it.
The worst bag looks like a Nike Swoosh (their trademark) or crescent moon shape about 1/2" below the orbital bone rim--I have prominant cheek bones. It's worse or more noticeable in certain lighting. Since this puffy area rests about 1/2" below the top ridge of my orbital bone, there's a slightly concave area between the top of the orbital bone and the beginning of the puffy area. Does that make sense? Anyway, he suggested filling in the area the below the bags, slightly and very deeply??? The way he explained it was a little lost on me, but he was confident it would help. In hindsight, it was not such a good plan. Since he injected the Juvy, the bag looks MUCH more noticeable to me. He went deep as it hurt a lot. I'm worried that since this area was already susceptible to swelling/edema anyway, that even after the Juvey dissipates, it will always look worse.

Okay, background info done...Here is my question: I know malar bags are the bane of existence for most PSs as there appears little solution for them. But, based on my description, could some type of filler be put in between the orbital rim and the puffy area to make it all one level and perhaps make a smoother transition (more of a half moon than a crescent) or would that just make this all that much more puffy looking?

I should have left it alone but others have had success with fillers in this area and this new fellow came highly recommended. Now I'm left with a more noticeable problem than I had. Suggestions? Sorry this was so long, I have a problem with brevity.

Thank you very much.

D


hi D
first off, get the juvederm dissolved with hyaluronidase. there's no reason for you to suffer for a year and a half with larger malar bags.
in terms of whether anything else would work, i'd have to see a picture of you to know for sure, but in general when injecting the undereye area, an experienced injector is extremely important. so, make sure that this doc has done alot of this specific procedure.
also, don't lose hope. i have had patients where we went back and forth a few times - filling it in and bringing it down, but it looked really good in the end and lasted several years.
cheers,