The under-eyes are a delicate area. The skin is thinner and more sensitive, and for many people, the area is prone to eye bags (puffiness) and dark circles. For this reason, under-eye treatments are one of the most common reasons that people visit cosmetic dermatologists.
While topicals like caffeinated eye creams, illuminating concealers, and under-eye gels may improve eye bags, nothing compares to the results you can achieve from visiting a board-certified dermatologist for an in-office treatment. One such in-office treatment for under-eyes is Volbella, a hyaluronic acid-based injectable under the Juvederm umbrella. It's technically only FDA-approved for lips, but dermatologists use the injectable off-label to deliver some serious results for under-eyes. Curious about treating your under-eyes with Volbella? Only a dermatologist will be able to tell you if you're a candidate and if it's the best treatment option for you. But in the meantime, here's everything you need to know before your appointment, according to board-certified dermatologist Dr. Robyn Gmyrek.
Meet the Expert
Dr. Robyn Gmyrek is a board-certified dermatologist based out of Park View Laser Dermatology in Manhattan, New York. Dr. Gmyrek is also a Diplomat of the American Board of Dermatology and has lectured nationally on the effective use of filler for wrinkles, her renowned Botox techniques, and more.
What Is Volbella?
Volbella is an FDA-approved hyaluronic acid gel injectable made by Allergan and part of the Juvederm family. While the filler is technically FDA-approved, it only is for the use of enhancing lip definition and fullness, as well as minimizing the appearance of fine lines surrounding the mouth. That said, Dr. Robyn Gmyrek, a board-certified dermatologist at Park View Last Dermatology in Manhattan, says that, like Botox and other injectables, Volbella is used “off label” by injectors to treat other areas of the face, including the tear trough area.
Benefits of Volbella
- Thinner than other injectables
- Best suited for delicate areas of skin (compared to other injectables)
- Smoothes texture
- Decreases swelling
- Reduces puffiness
- Long-lasting results
“The fact that Volbella is a thinner filler [makes it] ideally suited for areas where the skin is delicate, like the lips and under eye area,” Gmyrek says. “In addition, the hyaluronic acid in Volbella is created with a proprietary technology called VYCROSS, where the hyaluronic acid is cross-linked to improve the smoothness of the gel. It also decreases the amount of swelling that occurs with the filler and makes Volbella more resistant to being broken down by the body, so that it lasts longer.”
How to Prepare for Volbella
Like most injectable treatments, Volbella requires you to make a few changes leading up to the day of injections.
“Stop any blood thinners such as aspirin or ibuprofen (including advil, aleve, and motrin) unless they have been prescribed by a doctor for a medical condition and cannot be stopped,” Gmyrek advises. “Aspirin and aspirin-containing products should be stopped seven to 10 days prior to your injection, and ibuprofen at least two days prior.”
Not sure how pain relievers can make a difference with your treatment? Since these products act as blood thinners, they inadvertently work as bruise aggravators, so if you stay on them leading into treatment, you may be met with severe bruising posting injection.
In addition to cutting out aspirin and ibuprofen, Gmyrek says to lay off alcohol for at least two days prior to injections—again, to avoid unnecessary bruising.
While the aforementioned items are the most obvious blood thinners, Gmyrek adds that St. John’s Wort, vitamin E supplements, fish oil supplements, flaxseed oils, ginseng, ginkgo, and excessive garlic or garlic tablets should also be avoided in the week leading up to treatment, as these may also thin your blood and lead to excess bruising.
What to Expect During a Volbella Under-Eye Treatment
The process is simple. Upon entering your treatment room, your injector will apply numbing cream and allow it to set in for a few minutes prior to treatment. If you’re particularly sensitive to pain and needle pricks, Gmyrek says that lidocaine can be injected into the area first for comfort.
Once numbed, the injection site—in this case, the under-eye area—is wiped with an antibacterial wipe and prepped for the needle or cannula (depending on where you go, the injector may use either or). If they opt for a needle, Gmyrek says that it will be very small and inserted at a 45-degree angle to inject the filler. If a cannula is used, Gmyrek says that the process will still start with a needle prick. “A cannula is a blunt-tipped needle,” she explains. “Because a cannula is not sharp, an opening must be made with a sharp needle on the skin first and then the cannula is introduced into that opening. You may feel a pressure or pushing sensation as the cannula is introduced into and under the skin.”
While both techniques are commonplace for Volbella injections, Gmyrek says that they each have their advantages. “The needle is very precise; the cannula, because it is blunt and not sharp, has less chance of puncturing a blood vessel and causing bruising; and less chance of vascular occlusion,” she explains.
Regardless of which is used, Gmyrek says that, overall, Volbella injections are not very painful. “However, because we are working around the eye, it can be a little bit anxiety provoking for patients,” she adds.
Volbella vs. Other Fillers
Thanks to it’s ultra-smooth nature, Gmyrek says that Volbella offers a more natural result than other fillers on the market (though, she doesn’t directly naysay other brands). Additionally, she says that the texture of Volbella allows it to better adhere, offering a longer life span—up to 12 months, she points out.
Potential Side Effects
- Lumpy appearance
- Allergic reactions
- Vascular occlusion
More often than not, Volbella injections for under-eye bags are met with little to no side effects. That said, if you’re considering getting them, it’s important to know what could happen in the worst case scenario.
“Bruising is a real possibility,” Gmyrek starts. “This tends to be more common when using a needle and less common (but not impossible) using a blunt-tipped cannula.” The reason bruising is possible goes beyond the device used, though. “There are hundreds of small blood vessels in this area of delicate skin and if one is torn or pierced a bruise will occur,” Gmyrek explains.
Another possibility is swelling. While Volbella injections help to diminish puffiness in the long run, Gmyrek says that swelling will persist for four or five days post treatment. “Rarely, swelling after tear trough filler can last weeks to months because the filler can block lymphatic drainage from the area under the eye,” she adds.
When swelling becomes more severe, Gmyrek says that the under-eye area can look lumpy. While this is typically temporary—that is, if it occurs at all—she says to go back to your doctor if the lumpiness lasts for more than two weeks.
As with any injectable, allergic reactions are possible. For this reason, it’s important to tell your injector if you have a history of severe allergic or anaphylactic reactions.
Then there’s the chance of your under-eye injections causing hypersensitivity in the area. “Very rarely, products with Vycross technology, like Volbella can cause delayed hypersensitivity reactions weeks to months later,” Gmyrek says. “This would appear as pink or red nodules on or under the skin.”
Lastly, vascular occlusion—which is very rare—can occur. “Vascular occlusion can occur with any filler, in any area of the face,” Gmyrek explains. “It occurs when filler gets into a blood vessel, preventing the flow of blood. The result of this occlusion depends on what area the blood vessel was supplying blood to. If it was the skin, the skin in that area would not get blood and might break down and lead to a wound, possibly healing with a scar. If the blood vessel was going into the eye to supply the retinal artery, it could even lead to blindness. This is very rare, of course. While this can happen even to the most qualified injectors, it is very important to go to a provider that knows the anatomy, has experience, and knows what to do in case of a vascular occlusion.”
Thanks to Volbella’s longer-lasting nature, Gmyrek admits that it’s often priced a bit higher than other fillers. As a general rule of thumb, the more challenging the area being treated and the more metropolitan the area in which the practice is located, the higher the price is going to be. When it comes to Volbella for under-eye bags, Gmyrek says that prices vary from $600 to $1,500.
Good news: Once your treatment is over and done with, you have the perfect excuse to sit back and relax for the next 48 hours. While there’s no major aftercare necessary, Gmyrek says it’s best to take it easy and avoid any strenuous exercise or activities that increase blood flow, as they can trigger bruising. Once those 48 hours are up, feel free to return to your normal life—sans under-eye bags, of course.
The Final Takeaway
If you’ve tried every puffy-eye product the market has to offer, and if you’ve tested your hand (er, mouth) at drinking more water in an attempt to alter your skin from the inside out to no avail, getting Volbella for under-eye bags might just be the next best option for you. Only you—with the help of your dermatologist or another qualified injector—will know for sure.
Hamman MS, Goldman MP. Minimizing Bruising Following Fillers and Other Cosmetic Injectables. J Clin Aesthet Dermatol. 2013;6(8):16-18.