Complications from Under Eye Facial Filler | Miami, FL

Some of the most common reasons for complications from under eye facial filler injections leading to unsatisfactory results can include the following:

The wrong type of facial filler product was used for your eyelid anatomy.

Facial fillers that are derived from hyaluronic acids (HA) are generally considered to be the safest options for treating the sensitive under-eye area. These products include options such as the Juvéderm® family of products, the Restylane® family of products, and Belotero Balance®. One major reason for the general safety of these products is that they can all be dissolved to reverse the effects of the product. The medicine that dissolves these facial fillers is called hyaluronidase, and it works as an enzyme to break down these products.

In the United States, hyaluronidase is only commercially available for purchase by a physician or for use in a medical or surgical facility. Although HA fillers are generally known to last in other areas of the face for shorter time periods of six months to one year, it is common for HA filler products to last in the under-eye area for much longer periods of time. Often, HA facial fillers can still be observed in the under-eye area for many years after they were injected (in some cases, this can be five years later or more). For this reason, hyaluronidase injections remain a major therapy option to treat unwanted facial filler product in the lower eyelids.

If hyaluronidase injections are recommended for your condition, these will likely be incorporated into your treatment plan, and you will be required to return for an additional visit to examine the treated area after the hyaluronidase injections have been given sufficient time to work. In some cases, the results from hyaluronidase injections may be seen very quickly (within minutes), although it generally takes a little more time for the area to stabilize before a proper evaluation for additional treatment options can be performed. Dr. Lewen will typically schedule patients receiving hyaluronidase injections to return to the office for recheck a few days after having the treatment performed.

Even though there are many facial filler products that are composed of hyaluronic acids, this does not mean that all HA facial filler products are created equally. There are some products that are much more ideal for treating this delicate area of the face, while other products may tend to absorb more water or spread out more in the tissue, and are therefore more likely to cause long-term issues with swelling in this area after injection. Dr. Lewen only utilizes very specific facial filler products to treat this sensitive area of the face, based on scientific properties that have been studied and well-demonstrated to produce smooth and reliable results, along with less risk for unwanted side effects.

There are several other facial filler products that have been used to treat the lower eyelid hollows, and that are not made of hyaluronic acids. These products include: silicone, collagen, Sculptra®, Radiesse®, and Artefill®, as well as some others that are not commercially available in the United States, and in some cases, are not meant to be injected into the body at all. These products cannot be dissolved with hyaluronidase, and often cause significant issues when injected into the under-eye areas that can be very difficult to treat. While some of these products can give excellent results in other parts of the face and body, unfortunately, complications from these types of products used in the lower eyelid areas may require more extensive surgical revision procedures, and often there are still significant risks of permanent scarring, as well as other long-term issues.

Your eyelid or facial anatomy might not be ideal for this procedure.

Not every patient who has the appearance of tear troughs or lower eyelid hollows is a good candidate for facial filler injections in this area. In some cases, the anatomy of the lower eyelids can cause some people to have undesirable results with attempted tear trough rejuvenation. In these cases, surgical rejuvenation of the lower eyelids is often the most appropriate management, and surgery may be required to attain the best possible cosmetic result. Some examples of these eyelid or facial conditions include:

• Patients who have too much laxity (looseness) of the lower eyelids do not have the proper tension of the lower eyelids on the surface of the eye. With normal blinking, loose lower eyelids will bump along the surface of the eye, much like loose windshield wipers would bump along the windshield on your car. This creates an uneven tear film, which can contribute to chronic dry eye issues, and can also sometimes cause problems with chronic tearing, which can be quite annoying. Some causes for this condition can include: normal aging, chronic eye rubbing, floppy eyelid syndrome, sleep apnea or other sleep disorders, previous eye or eyelid surgery, chronic sun damage, and conditions that cause scar tissue formation in the skin near the eyes. This condition can contribute to issues with chronic inflammation in the lower eyelids, and may cause prolonged or excess swelling to be present at some point after having facial filler products injected into the area. Hyaluronidase injections are typically used to dissolve the facial filler product, and then a surgical repair of the lower eyelid tension issue can be performed.
• Patients who have too much laxity (looseness) of the lower eyelid muscle (orbicularis oculi) can also develop issues with the positioning of the lower eyelid on the surface of the eye. While normal eyelid muscle tissue will snap the eyelids shut quickly with every blink, loose eyelid muscle tissue can cause the blink reflex to be much weaker. Along with chronic dry eye issues, this can also contribute to prolonged or excess inflammation in the lower eyelids, and may cause prolonged or excess swelling to be present at some point after having facial filler products injected into the area. Hyaluronidase injections are typically used to dissolve the facial filler product, and then a surgical repair of the lower eyelid muscle issue can be performed.
• Patients who have larger lower eyelid bags are usually not ideal candidates for facial filler injections into the tear trough or lower eyelid hollows. The pre-existing larger volume and heaviness of the eyelid bags may not be well concealed by facial filler injections in this area, and sometimes, the added volume here can create a very unnatural look. Additionally, many of these patients may require cheek augmentation and support of some kind, and the absence of volume in this area relative to a much fuller lower eyelid area can result in some abnormal facial proportions that can create an unbalanced and undesirable appearance. Hyaluronidase injections are typically used to dissolve the unwanted facial filler product, and then a proper surgical rejuvenation with an individualized cosmetic lower eyelid blepharoplasty can be performed.
• Festoons (also known as malar mounds) are typically seen as a pouch of tissue that may appear puffy or filled with fluid, and are located in the cheek area just below the border of the lower eyelid. Festoons are thought to be the result of sun damage over time, and are related to various muscle forces in the face. In some cases, facial filler injections that are placed underneath the eyes can lead to additional swelling, and can make a festoon pocket appear more evident or larger. At times, the festoon pocket may persist for a longer period even after an unwanted facial filler product is dissolved with hyaluronidase. Effective treatments to eliminate festoons may include a more extensive version of lower eyelid blepharoplasty surgery, as well as possible CO2 laser resurfacing to eliminate the festoon pocket.

The person who performed your treatment was not appropriately qualified to perform this specialty injection.

Facial filler injections have now become wildly popular non-surgical treatments both in the United States and around the world. Nowadays, there are several types of medical practitioners who perform facial filler injections.

Although there is a core group of physicians who are traditionally trained in these treatments for cosmetic enhancement, this also includes many other types of doctors who were originally trained in other specialties, and who may not have the same extensive training or background in the delicate anatomy of the eyelids or similar areas of the face. In many areas of the country, this also includes a group of non-physician extenders such as nurse practitioners, registered nurses, physician assistants, and medical aestheticians. Depending on local laws, these practitioners may or may not be directly supervised by a physician.

Unfortunately, there are also people who illegally perform facial filler injections without any medical training at all, and sadly, these are typically the horror stories you may see on the evening news. With all of these different types of doctors and medical professionals performing facial filler injections, there can be a large amount of variability in the treatments that are performed. In other words, a syringe of Restylane® injected by one person is NOT the same as the same syringe injected by another person!

When considering a revision procedure after an unsatisfactory result from under eye facial filler injections (non-surgical tear trough rejuvenation), it is very important to do your homework regarding the education, background, training, and experience of a qualified surgeon. For issues involving this delicate area of the face, it is highly recommended to seek the care of a fellowship-trained oculofacial plastic surgeon for such revision procedures.

An oculofacial plastic surgeon should have a board certification in general ophthalmology, and advanced sub-specialty fellowship training in the field of oculofacial plastic surgery (aka: oculoplastic surgery or eye plastic surgery).The main reason why this is so important—particularly for revision procedures following unsuccessful under eye facial filler injections—is because the health and safety of your eyes and vision must be maintained, while also achieving a cosmetic improvement, in order to attain your best results.

After having a complication from under eye facial filler injections, your eyelid tissues may be somewhat compromised, and you may experience other significant symptoms such as blurry vision, eye pain, tearing, burning, dry eyes, an inability to close the eyes completely, double vision, and/or problems with your normal blinking.

If any such symptoms are present, these important issues must be examined and effectively addressed as an important part of any plan for a successful revision after a complication from under eye facial filler injections. It is also important to understand that revision procedures after an unsatisfactory result from previous under eye facial filler injections can sometimes be more complex than the original procedure, and there may be certain steps that must be followed as part of a treatment plan in order to properly address the area of concern.

During your consultation, Dr. Lewen will perform a careful examination of the affected lower eyelid area. Afterwards, he will work with you to create a customized treatment plan that best addresses your specific and individual condition, including your best cosmetic revision options to give you the best possible results.