In general I can give patients a very good idea of how much filler around the eyes they will need before starting. That is why a consultation is so important. I can give most patients a reasonable idea based on a good quality photograph. Determining how much volume will be needed also depends on your aesthetic goals for what you want your eyes to look like. Some patients desire a very full look while others would just like to fill in some of the hollowness around the eyes.

As a rough starting point, an average patient will need anywhere from 1/2 a cc to 1cc of filler in each upper eyelid. Same goes for the lower eyelid or under eye area. If there is a considerable degree of hollowness you might need as much as 2 cc in each upper eyelid or under eye. This will be discussed during your consultation.

To learn more about fillers around the eyes click here for the eyelid procedures page

The under eye area is extremely vascular and delicate. It is possible to inject filler under the eye while on plavix, but this will certainly increase the probability of a bruise. Since botox is applied very superficially in the skin, there is a much smaller chance of bruising than with restylane under the eyes as that is injected much more deeply.

There are several possible reasons why your under eye area is puffy now.

1. It could be that too much juvederm was injected under your eyes causing there to be puffyness and bagging now.
2. Some people get a lot of swelling from juvederm under the eyes (that is the main reason I prefer Restylane under the eyes).
3. Even if the under eye filler was done perfectly, if you have a very flat sunken in cheek it could cause your under eyes to appear puffy until the cheek is filled a bit as well.

Your face needs to be evaluated as a whole. There are certain relationships that need to be maintained between different features of the face. If those relationships are compromised things look weird or off. For example, many women get their cheeks filled with filler. Even if the cheek filler was done perfectly the cheeks might now look out of balance with the rest of the face and hence look "artificial." For example, filling the cheeks alone might now make the under eye area look more hollow and sunken, and also might make the temple look more hollow and sunken.

Any idiot can take some filler and inject it into people's faces. The art is in anticipating how the filler will make your face look and where exactly should it go to make you look better and more natural, not artificial and puffy.

So what can you do regarding your under eye bags? Well, you need to be evaluated to see why it looks puffy. The filler might need to be dissolved if there is too much of it, or your cheeks might need to be addressed if it is because your cheeks are too sunken.

If a filler agent such as juvederm or restylane is placed too superficially in the skin, it could cause this bluish effect you are describing.

The only way to reverse it is to dissolve the juvederm, which is possible, which will get rid of the bluish color. Afterward if you would like you can have the filler placed again but at a deeper level so it does not cause the blue effect again.