What can I expect from under-eye filler treatment? Every day in my practice I use
fillers under the eyes to address hollowness to camouflage eye bags and to
even improve the appearance of wrinkles under-eye filler treatment can be
performed very quickly and results can often be appreciated right after the
procedure is performed there are different ways to perform these
procedures in this delicate region I routinely see patients who come in
having had filler placement performed by another practitioner resulting in severe
swelling lumps and irregularities as well as dissatisfaction with their
results I’ll explain how I approach injectable fillers under the eyes from
the perspective of a cosmetic eyelid surgery specialist

I’m Dr. Amiya Prasad I’m a Board-certified cosmetic surgeon and
Fellowship-trained oculofacial plastic and reconstructive surgeon I’ve been in
practice in Manhattan and Long Island for over 20 years I perform cosmetic
eyelid surgery everyday for conditions such as hooded upper eyelids and under
eye bags I also perform specialized eyelid surgeries such as Asian double
eyelid surgery eyelid ptosis correction and eyelid retraction repair I also
specialize in revision surgery for complications occurring after eyelid
surgery refer to me by other doctors I routinely perform non-surgical
injectable treatments every day for the under eye area for the crow’s feet lines
for upper eyelids and for lips I’m also well known for performing a technique of
Structural Volumizing derived from principles used in facial implant
surgery to naturally enhance areas such as the chin
cheekbones and jaw angle with thicker and longer lasting hyaluronic acid
fillers a common question about under-eye filler treatment is if there
are permanent options available since fillers such as hyaluronic acid fillers
are metabolized I explained that prior to the introduction of hyaluronic acid
fillers I performed a placement of silicone tear trough implants
although implants are permanent facial aging continues which means bone volume
progressively diminishes as does the thickness and skin and the fat around
the eyes as well as the cheeks further in my experience patients appreciate the
convenience safety reversibility of hyaluronic acid fillers which are placed
in my exam room with minimal downtime this is in contrast to a surgical
procedure with downtime that is more than a week I’m able to use the same
principles for facial implant surgery and create highly accurate enhancement
by placing volume to compensate for natural asymmetries in the face which
just cannot be done with the same level of precision when placing facial
implants so what are the particular aspects of the under eye area which need
to be factored in when planning filler placement
well the under eye area is highly vascular so the risk of bruising needs
to be reduced as much as possible I perform these procedures with
instruments called blunt cannulas which allow me to avoid trauma to the blood
vessels this means that patients usually look good right after the procedure is
completed I approach filler treatment with the same level of care as I do with
surgery while filler treatment is not surgery I do consider it invasive since
the filler is being placed through the skin barrier although it’s rare
injection of filler can go directly into a blood
vessel or artery in this area resulting in vascular occlusion causing blindness
as the number of practitioners performing this procedure grows many of
whom are not trained or experienced at a specialty level comparable to an
oculoplastic surgeon there are more complications being reported while there
are risks to any medical procedure these risks can be minimized by having a
doctor who is highly trained and experienced and fully prepared to
immediately address any complication there is a small risk of infection from
the placement of hyaluronic acid fillers since the needle or cannula can
introduce bacteria from the skin surface and cause an infection known as biofilm
on the surface of the filler material fillers can also become encapsulated
where the body forms a shell around the material these issues can be addressed
by dissolving the filler with the enzyme hyaluronidase hollowness under the eyes
is often accompanied by the presence of dark circles to improve the appearance
of the skin which is contributing to the appearance of dark circles I often use
PRP or platelet-rich plasma PRP is a concentration of wound healing and
growth factors present in your blood which is harvested by drawing your blood
as you would for a routine lab test and concentrating the platelets into a clear
yellow serum combining PRP with hyaluronic acid filler can have a
synergistic effect and make a very nice impact on the tired look of hollow eyes
with dark circles interestingly I have found many people with under-eye bags
come in for filler treatment because they see the hollow areas of the tear
trough and don’t realize that they also have puffiness I use fillers routinely
to camouflage eye bags if they are not too prominent by
blending the transition between the puffiness and the adjacent hollow in the
area of the tear trough if under-eye bags
reach beyond a certain threshold treating them with filler may actually
make the bags appear even more puffy I see patients who had fillers placed
elsewhere in this situation and I use hyaluronidase to dissolve the filler I
then really in two weeks to see a filler is still a viable option or if lower
eyelid blepharoplasty is more appropriate I find it’s important to
educate my patient about the relationship between the under eye
hollows and the cheek areas it’s very common to see a deficiency in the
projection of the cheek area just below the tear trough and the under eye as
well as the cheek bone this means that there is often a great opportunity to
create a more significant improvement by combining under-eye filler with
structural volumizing of the cheek and the cheek bones sometimes my patients
express a concern about the potential for having rounded cheeks which they see
in their social circles or in the media I explained that this appearance occurs
when filler is placed just below the skin which does not create definition I
place volume at the bone level as if I were placing a facial implant with
minimal trauma and typically no bruising this creates a harmonious relationship
between the under eye and cheek area which can be very flattering for the
face as a whole a hollow appearance under the eyes can
have a significant effect on how people look at you
in my practice I approach this area with an understanding of the deeper bone
structure which comes from performing surgery essentially I take an inside-out
perspective help my patients recognize how cheek volume
and skin quality under the eyes can also be improved to help them look better has
been invaluable for my patients who then enjoy the benefits of looking more
energetic and confident it’s important to remember that fillers are invasive
procedures and should be taken as seriously as surgery this mean that it’s
in your best interest to take steps to ensure your safety particularly in case
a complication were to arise safety predictability reversibility and minimal
downtime are the guiding principles which I use to help my patients look
their best I hope you found this information helpful
thank you for your question