A particular benefit of using a hyaluronic acid filler is that if the need arises, the procedure can be reversed. The hyaluronic acid fillers can be dissolved with the enzyme hyaluronidase for complete reversal and safe absorption by the body.
Dr. Prasad often combines a cosmetic filler with platelet-rich plasma (PRP) under the eyes. This creates a synergistic benefit of improving skin quality, color, volume, and also to potentially extend the effect of the filler. Platelet-rich plasma is derived from the patient’s own blood, which is spun down to separate red blood cells. The concentrated plasma containing various growth and healing factors which are important to heal cuts and wounds.
The concentration of these growth and healing factors stimulate collagen. Stimulate the creation of new blood vessels, improve circulation, and improve skin thickness and volume. PRP improves the quality and health of lower eyelid skin affected by pigmentation issues and iron deposits that cause discoloration.
There is a perception that lower eyelid hollowing is best treated with transferring/grafting a person’s own fat. This perception is understandable as fat is already part of a person’s anatomy. However, transferring fat is deceptively complex and unpredictable for several reasons.
Fat is a texturally inconsistent material, so lumps, bumps, and discoloration are likely issues which can be seen through thin eyelid skin. Fat also needs to be transferred to readily available blood supply in the area. If the fat does not heal as intended, removing it is an intricate and costly procedure.
Fat can also be quickly absorbed by the body. Anywhere from 30-70% may be lost due to absorption, making an additional volume enhancement procedure necessary. Fat grafting is a double surgical procedure: one to harvest the fat, and one to place it. “Touch ups” due to fat absorption requires another surgical procedures. Removal of transferred fat due to complications is an extensive and expensive surgical procedure after fat grafting. This is in comparison to dissolution of hyaluronic acid filler which takes minutes and does not require open surgery.
A specialized technique of placing fillers at the cheeks and other facial areas is called Structural Volumizing, or the Y Lift® method. Structural volumizing places long-lasting fillers at the bone level to address bone loss due to aging, providing foundational volume.
This is in stark contrast to fillers normally placed in soft tissue, which may not support the weight of the filler. Resulting in the material weighing down the face, or resulting in a doughy or pillowy appearance. With the strong foundation of bone and held in place by the facial muscle layer, Structural Volumizing adds definition and youthful fullness, with natural looking results. More filler volume can be placed with Structural Volumizing than traditional filler placement. The weight sits atop the bone structure, and muscle retains the desired shape far better than fat and soft tissue.
Overall, I am very happy with the work I had done. My jaw area especially has given me the confidence that I never had, you know, my whole life. I feel like I can hold my head up, you know, strong. I always felt uncomfortable about my profile, so it’s all good. I’ve been told that, by my boyfriend, that I really don’t have any lines and that I just look more vibrant, so you know, that’s a great feeling—to have that feedback. So, two weeks in, and you know, it’s the new me. So, I’m happy.
Cosmetic fillers to treat under eye bags is one of the most sought treatments in cosmetic medicine. Its popularity is due to eye bags being one of the most common aesthetic issues. Under eye bags is most frequently due to genetics, not aging, so many young people are dealing with it.
The most common complaints of young people about eye bags are they make them seem more tired, weary, and older than they actually are. Fillers are most often sought to treat eye bags because it is quite typical to be their first ever cosmetic procedure.
Eye bags can be treated without surgery using injectable fillers, but only in cases where the eye bags are slight. This may go against recommendations of other doctors who may say that almost any case of eye bags can be addressed with filler.
As a specialist of the eyelids Dr. Prasad frequently counsels his patients that fillers are not appropriate for all eye bags cases. Fillers can paradoxically add more volume to the under eye area where fat is already causing large eye bags. So an attempt to camouflage the puffiness often makes the situation worse.
Slight cases of eye bags can be treated by blending the hollow tear trough with the adjacent puffiness under the eyes. A hollow tear trough can make eye bags appear larger. Think of the hollow tear trough as a valley, while the eye bags are a mountain next to the valley. By filling the depth of the valley with a filler, the mountain next to it won’t appear so large.
However, with larger eye bags, attempting to add filler to camouflage it can make the under eye area look more voluminous. And will likely make the eye bags appear even larger than prior to treatment.
As an Eyelid Specialist surgeon, Dr. Prasad often sees cases of overfilled under eyes. Frequently dissolves the hyaluronic acid filler with the enzyme hyaluronidase. From there, he decides if the eye bags can still be blended with filler. Or if the fat causing the eye bags requires surgical removal.
Can I treat eye bags with cosmetic filler instead of surgery?
Under eye fillers have become a popular and convenient way to help improve the appearance
of under eye bags.
Filler placement under the eyes require no surgery, and can be performed in minutes to help camouflage under eye bags..
This procedure can be performed with minimal to no bruising.
It’s important to understand that under eye filler cannot be used in all cases of under eye bags, and that surgery is often the better option.
I’m Dr Amiya Prasad. I’m a Board Certified Cosmetic Surgeon and Fellowship Trained Oculoplastic Surgeon. I’ve been in practice in Manhattan and Long Island for over 20 years.
As a cosmetic eyelid surgery specialist, I perform a wide range eyelid procedures every day such as eye bag removal, treatment of upper eyelid hooding, Asian double eyelid surgery, and oculoplastic specialty procedures such as eyelid ptosis correction, orbital and lacrimal system surgery..
I am also well known for my work with injectable fillers for the face, particularly in the the eye area, cheeks, chin, jawline, and forehead.
Essentially, unlike physicians who cannot perform surgery, I am not limited or biased in treating the under eye area with any modality.
Many people with under eye bags are relatively young and often hesitant to consider surgery preferring to have the under eye area treated with filler.
While eye bags can occur and become more prominent due to age, they are mostly caused by genetics, and can occur as early as during the teen years, and in some cases even younger.
So, what are eye bags ? Eye bags are caused by fat.
Fat normally surrounds the eyes can push forward, like a hernia.
This is why the fat that causes eye bags is referred to as herniated fat.
Fat herniation under the eyes is called lower eyelid fat prolapse.
During consultation, I look at the prominence of the fat and relationship of the herniated fat to the surrounding bone structure.
For example, there is an area below the under eye bag referred to as the tear trough.
I look to see if the puffiness can be blended with filler in the tear trough.
Generally, I use soft tissue fillers such as Restylane or Juvederm in this area as long as the under eye bags aren’t too prominent.
It’s important to understand that fillers improve the appearance of eye bags, not by reducing projection, but by adding projection to the adjacent area.
In some situations where the bags are too prominent for optimal blending, I perform this procedure as a short term solution for people who want to look better and will undergo surgery later on.
If the under eye bag projection is past a certain limit, as in the case of more prominent or severe eye bags, then adding additional volume may not blend the contour of the eye bags, and actually add more puffiness to the area, making the eye bags look even more prominent.
When selecting a doctor, keep this in mind that many doctors who are not surgeons will choose filler to treat all eye bags cases, which means in many situations, the filler placement can result in bigger eye bags.
When eye bags are past a certain level of projection, fillers are not appropriate and surgery is the treatment of choice.
This surgery is referred to as lower eyelid blepharoplasty. There are two techniques, one is called the transcutaneous approach where an incision is made below the eyelashes, to address the fat bags.
The other approach is referred to as the transconjunctival approach where the fat pockets are addressed from the inside of the eyelids.
In practice, it is common for many doctors to perform the transcutaneous approach to also remove eyelid skin in an attempt to reduce wrinkling.
In almost all cases, I strongly advise that lower eyelid skin not be removed as it can lead to complications such as rounding of the eyes, or eye exposure from skin shortage known as lower eyelid retraction.
Oftentimes, the inside of eyelid is exposed and irritated is due to skin removal.
This condition is referred to as ectropion.
My preferred method is a more specialized technique called transconjunctival blepharoplasty, where no external incision is made.
I approach the fat pockets from the inside of the eyelid to sculpt the fat.
Since no external incision is made, the results look natural, as if you never had eye bags.
This method preserves the lower eyelid support structures since no skin is removed, and the anatomy of the eyelid is not compromised by disruption of the muscular support..
When performing eyelid surgery, I most often sculpt the fat to remove the bulge, but leave some fat behind to create a smooth contour in the lower eyelids, and prevent the lower eyelids from looking hollow.
Lower eyelid surgery is an art, so not all surgeries are performed the same way.
Having this procedure done with no external incision allow the results to appear natural, and preservation of fat to prevent hollowed appearance provides for optimal outcomes when performed by experienced surgeons.
Injectable fillers placed under the eyes is routinely performed with topical anesthetic for patient comfort.
In addition, fillers like Restylane are also contain some anesthetic.
I usually prefer instruments such as blunt-tipped cannulas instead of needles to reduce the risk of bruising after the procedure and minimize swelling caused by repeated needle entry.
Generally there is minimal downtime and I see the patient again two weeks after the procedure to see how the filler has settled, and if additional enhancement is needed.
In my practice, eye bag surgery through the transconjunctival method is performed with local anesthesia, with LITE sedation for comfort.
I prefer local anesthesia with sedation for almost all my surgeries as my patients are more comfortable and able to avoid the recovery from the side effects of general anesthesia.
Consequently, my approach results in easier recovery and fast healing from the surgery.
Surgery in my practice is performed in our own in-office surgical suite, certified by the Joint-Commission for standards of safety and sterility.
Patients routinely go home after surgery without any difficulty..
As far as downtime, patients can return to work pretty much immediately after under eye filler.
In fact, many patients do it over their lunch hour, and return to work afterwards.
There is the possibility of of some bruising after the procedure which typically fades in a few days.
When performed with local anesthesia, lower eyelid surgery patients return to work in about a week.
Interestingly, we have found that the limited bruising from lower eyelid surgery can be comparable to the bruising seen with the use of fillers.
Oftentimes, patients have much less bruising after my performing lower eyelid surgery than patients who’ve had filler procedures done elsewhere.
The techniques I’ve developed over my career combined with the systems for care and recovery allow my patients to recovery from lower eyelid surgery much faster than traditional surgery.
I discuss with my patients how to look at their options from a perspective of procedure longevity.
Softer hyaluronic acid fillers like Restylane can last 6 months to 1 year before they are eventually and safely broken down by the body.
The benefits of lower eyelid surgery can last many years.
Once fat pockets are removed, those fat pockets don’t come back.
While there is a chance that other fat around the eyes can prolapse forward the eyelid appearance can be stable for many years.
Neither fillers or lower eyelid surgery address skin quality such as crepiness.
Supplementary procedures for eyelid skin rejuvenation treatments like laser resurfacing, wrinkle treatment, and platelet-rich plasma may be considered to address crepey skin, pigmentation and wrinkles.
When can you look good for an event: If you want to look good for an event, both filler and surgery can be performed on relatively short notice.
I look at each individual situation and make recommendations based on my experience.
Filler placement is a convenient option for limited eye bags, with minimal to no recovery.
Lower eyelid surgery is a more definitive procedure that can be performed for any degree of fat prolapse, with results as if you’ve never had eye bags or surgery.
Patients often choose to have filler placement under the assumption that they don’t have time for surgery recovery.
In our practice, applying modern, faster healing methods, recovery from eye bag surgery can comparable to the time it takes for filler results to settle.
Lower eyelid blepharoplasty really brightens up the whole face with minimal surgery.
In fact, many patients who I’ve operated on, comment on the ease of their experience with their procedure and state that if they had been previously aware of how easy it was, they would have done it sooner.
I hope you found this information helpful…thank you for your question
While slight eye bags can be treated with filler, it is important to know that maintenance will be needed. Hyaluronic acid fillers are safely broken down by the body, so there is no actual danger.
Since fillers used in the under eye area are softer and less viscous, they also do not last as long as thicker fillers. Expect filler treatment for under eye bags to be repeated every 3-6 months. In contrast, removing eye bags surgically can last anywhere from years, decades, or can last permanently.
Board certified plastic surgeon Dr. Prasad almost always performs under eye bag surgery through the transconjunctival blepharoplasty method. The procedure is performed from behind the lower eyelid skin, where the fat that causes eye bags is removed, repositioned, and sculpted. It is important to leave some fat behind so the under eye area are not looking hollow.
Since there is no external incision, there is no chance of a telltale external scar of surgery. This is a more specialized technique when compared to the more common transcutaneous blepharoplasty. Transcutaneous method is practiced by most general plastic surgeons and non-eyelid specialist surgeons. It does require an external incision to remove and sculpt the fat that causes eye bags. Also, it is more prone to complications such as eyelid retraction and ectropion.
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
While it doesn’t usually doesn’t occur in Dr. Prasad’s hands, swelling or bruising of the under eye area is commonly seen after injectable filler treatment for eye bags. The bruising is temporary, and can last about a week. Similarly, recovery from transconjunctival blepharoplasty done under local anesthesia also lasts about a week. The difference here is that blepharoplasty to remove eye bags lasts for years, or even permanently. While filler treatment will need to be repeated, and recovery from bruising may need to be repeated as well.
Any medical procedures involve risks but risk can be minimized by having a highly-trained and experienced doctor. Although it is rare, filler can be injected into a blood vessel or artery causing blindness (vascular occlusion).
Other possible complications include infection in filler placement from skin surface bacteria and filler encapsulation. Incidence of complications, and addressing them immediately as they occur are advantages of having under eye fillers administered by the specialty level of or comparable to an oculoplastic surgeon. Read what to do when under eye fillers gone wrong
When your eye bags are serious or past a particular projection point, you are not a candidate for under eye fillers. The addition of fillers to the under eye area can result in the appearance of larger eye bags. Surgery is the preferred treatment for significant eye bags.
Under eye filler is effective for treating hollowness under the eyes, where a lack of volume can make the eyes look weary and tired.
The safest material to use is hyaluronic acid fillers, as hyaluronic acid is naturally present in the body, so there are no issues with tolerance or foreign body reactions. Hyaluronic acid fillers are safely metabolized with time. If someone doesn’t like the results of their under eye filler treatment, they can have the filler dissolved with injectable enzyme hyaluronidase.
It’s important to keep in mind that the doctor, not the material, determines the results of filler treatment. The results of filler treatment, and minimizing risks of complications are determined by the experience, expertise, and aesthetic style of the doctor. Think of the filler material as clay for a sculpture, and the doctor as the sculptor.