Lower eyelid fillers are now a common treatment for dark circles, lower lid hollows and “Bags.” The most common fillers used for these purposes are from a family of gels called Hyaluronic Acid gels. In the lower lids Juvederm and Restylane are two fillers from this material that have been used the most.
Placement of these fillers is generally safe with few complications. The most common issues are too much put in, too little put in, a bluish hue to the area of the fillers (called a Tyndall effect), and a swelling reaction (hydrophilic reaction). These issues can be managed by adding more filler when there is too little, and dissolving the filler for the remaining problems. The material we use to dissolve the filler is called Hyaluronidase. This is an enzyme with degrades (melts) the filler away. It is given by injection and within a short time the results are evident. The two most common brands of Hyaluronidase available are Vitrase and Hylenex. They both work and there are ongoing studies as to which may be better.
I only use Restylane in the lower lids as I feel its properties make it less prone to these issues as compared to Juvederm. While still possible, I have not seen these issues with Restylane.
Below (left) is an example of a woman who had a swelling reaction to Juvederm filler which is still present over a year after injection. On the right is her appearance within a day of Vitrase treatment to dissolve the Juvederm. As you can see it is much improved. What remains on the right lower lid (seen in the frontal view) is the natural fat (prominence) of her lower lid which can be removed surgically should she desire.
I am happy to answer any questions regarding the treatment of lower lid dark circles, hollows and bags with filler should you be interested http://www.drmassry.com