Why Hyaluronic Acid Cosmetic Fillers are Advised for Hollow Under Eyes Over Fat Grafting


What is the best treatment for my under eye? My under eye circles and hollowness came on
within the last 6 months. What direction should I go that will give me the best results? Thank you for your question! You submitted a single photo showing both
eyes and you are concern is about hollowness and dark circles that have appeared over the
course of the last 6 months. Well, looking at this photo, certainly I can
appreciate what you’re describing. I think the majority of your concern is in the area
we refer to as the tear trough. In addition, there’s also an area adjacent towards to
the center of each eye which is called the V deformity or the junction between the eyelid
and cheek where as we get older, we lose some volume. In your right eye, you appear to have
some puffiness in your outer aspect but this may be an artifact of the photo but in terms
of addressing relative hollowness of the eyes, we can certainly share our approach in our
practice. I’m a cosmetic oculofacial plastic surgeon.
I specialize in eyelid surgery and eyelid rejuvenation and practicing in Manhattan and
Long Island for over 20 years. This time in the medical field is an exciting time because
we now have more options that we used to for dealing with this volume loss. So in our practice,
our approach is to address volume with a filler such as hyaluronic acid. Hyaluronic acid comes
in many different brand names including Restylane, Juvederm and can really be very effective
in restoring contour in the really delicate area. The trick is to be able to place the
material into the areas that need to be placed and avoid lumpiness, irregularities and swelling.
A lot of times, people get a little bit ambitious and they fill more and they make the eyes
look more puffy. So there’s an art to that. And with that placement, you can really get
significant improvement. The way the skin of the eyelid, the thinnest skin of the body,
just rests against the bone when there’s less tissue between, it just makes the area
very dark. So a filler is a great solution and is worth exploring. The downside of fillers
is there is maintenance involved. And a lot of times, people want to go for
something permanent such as something like fat transfer. From my perspective, I have
not seen very good results from fat transfer. Fat grafting unfortunately, does not really
apply uniform filling and a lot of times, people can get irregularities and lumps. People
come to us from all over the world who have had fat grafting and we actually remove the
fat because they creates these irregularities and problems. So I tend to not use it. I like
to do things that are more predictable and are able to really minimize the patients down
time. In a world where everybody’s busy, prolonged swelling is not acceptable in any
reason. The other thing that we also do that is also
unique is something called platelet-rich plasma treatment. Platelet-rich plasma or PRP is
derived from your own blood. And what we are essentially doing is concentrating the platelets
and growth factors necessary for wound healing and applying them under the skin. And what
we have seen is improvement in color and quality and just overall health of the skin. in fact,
when we use PRP in the rest of the face, whether it’s for acne scars or just for complexion
improvement, the patients always come back with this nice glow because it stimulates
blood supply and this is something that makes it really different from fillers. So our approach
is to apply a synergy in this area. We do a filler for the volume and PRP to improve
the skin quality. And we have had a very high level of satisfaction from our patients. We
follow our patients closely to make sure the contour and shape is really nice and we always
tweak if necessary. Again, this is an art and it has done artfully. A lot of people
try to differentiate themselves saying they use different tools such as blunt cannulas
and other things to minimize bruising and certainly, that’s respectable and it depends
on the hands that use the instrument. But there’s an art and getting the material
in the right place in the right volume and getting the right shape is artistic. So I
can’t drive that point home enough. But the synergy with platelet-rich plasma has
been very effective. Now these fillers can last anywhere from 3
months, 6 months and even up to a year and even sometimes beyond. But it is individual
so you have to kind of see what works for you. It is very common or patients to ask
give me the longest filler. But very often, the longest lasting filler may be too thick
to use in this area so there’s always some type of customization that has to be part
of this and acceptance you’ll need to do this on some kind of regular basis. Facial
aging is volumetric loss, loss of bone, muscle and fat, so restoring volume strategically
and keeping a natural look is important and is a commitment. So with that being said, I hope that was helpful,
I wish you the best of luck and thank you for your question!

13 thoughts on “Why Hyaluronic Acid Cosmetic Fillers are Advised for Hollow Under Eyes Over Fat Grafting

  1. at what age can you get it .. and im 16 and i have really deep hollow under eyes because i had a bad habbit of rubbing my eyes.. my mum said drinking milk would help .. do you think drinking milj would help … my eyes are really really dark

  2. What about a cheek implant would that be a permanent solution?
    I have spoken with a surgeon who thinks that would help and my eyes are very similar to in the video. Despite for an answer as everyone thinks I'm a walking zombie I look so tired !!!

  3. Hiii doctor….i have been researching about fillers and was disheartened to know about the intravascular occlusion causing blindness albeit a rare complication but a devastating one may happen even with experienced doctors and h.a fillers….is it true?
    Getting fillers can make my life a lot easier but at the cost of above specified risk its totally not worth it….
    May i know your advise regarding this?
    I learnt the risk is more if injected around eyes/nose/forehead

  4. I have a question I hope you can answer – about a month ago I got my tear troughs done. Juvederm Volbella was used. Although I see improvement, I'm not happy with my results. I still see tons of fine lines and a small shadow on my face. I was expecting it to look somewhat smooth. Are my expectetations too high? I did research and looked at before/after.

  5. I'm a borderline for SLE and should be avoiding what ever is provoking and flaring it again..with what u suggest it looks like there is No filler option for any susceptible autoimmune cosmetic sseking

  6. I have naturally pronounced hereditary tear troughs (I'm also 25), and have always wanted to do something about them. I just had a consultation today for under eye fillers, and the nurse turned me away and said I was not a fit candidate because apparently she didn't want to hit a vein or nerve that she saw. She also said there's a chance the filler can damage the nerves under my eye and lead to complication. I have NO idea what is wrong with my under eyes?? Besides my tear toughs, and of course, the natural thin skin under the eye, my veins don't look any more pronounced than any of the people you showed in this video. I honestly wanted to cry today because she left me feeling like I have absolutely no options. I felt like she just lacks the expertise/artistic quality to be able to treat my tear troughs. She doesn't want to take the responsibility for the lack of her own knowledge and talent at doing this. I would like your opinion on whether or not you would turn away a patient for this treatment, and why?

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