These patients come to see me for bags under the eyes. They’ve generally forgotten about the injection of dark circles that may have taken place several years earlier, and are very surprised, because they rightly think that the hyaluronic acid has resorbed.
But it turns out that under the eye, hyaluronic acid either doesn’t reabsorb or takes several years to do so (I’ve seen patients with a hyaluronic acid pocket injected over five years ago).

On the plus side, there is now an antidote to hyaluronic acid: hyaluronidase, which dissolves all the injected acid.

This is a revolution in aesthetic medicine, as it’s the first time we’ve been able to dissolve a product that has just been injected (we have a real eraser and a pencil).

Intervention technique :

As always in this profession, you need a certain amount of experience to inject hyaluronidase.

• An anti-allergy test must first be carried out prior to injection (prick test on the forearm 24 hours before injection), to rule out patients allergic to hyaluronidase (very rare cases).
• Inject very small doses of hyaluronidase so as not to remove the hyaluronic acid from the dermis and hollow out even more than before the ring injection.

Conclusion:

I’m seeing more and more consultations for bags that have turned into hyaluronidase injections. These are false and iatrogenic bags, created by hyaluronic acid injections that are too superficial and in too large quantities.

To avoid this complication, I’ve always stressed the need to inject the hyaluronic acid into the cornea on the bone contact, to make sure it’s under the orbicularis muscle, and with very fine needles (32 gauges). The injection rate is therefore very low, preventing the injection of too large a quantity of product, and it must always be borne in mind that hyaluronic acid behaves like a sponge and swells after injection.

That’s why I always do my dark circle injections in 2 stages, 3 weeks apart, to make sure I don’t inject too much product.