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Under Eye Fillers: Treatment for Hollow Eyes, Tear Troughs, and Eye Bags
Softer cosmetic fillers offer a lot of versatility for issues under the eyes, from hollowness, deep tear troughs, and even slight under eye bags.
What Causes Hollow Eyes/ Tear Trough?
The under eye area may have a hollowed look due to:
- genetics
- volume loss due to aging
- from environmental and health factors such as excessive sun exposure, or
- habits such as cigarette smoking that can affect the skin internally and externally.
Best Under Eye Filler for Hollow Eyes/Tear Trough
Hollow eyes can be effectively treated with a softer hyaluronic acid filler such as Restylane, Restylane Silk, or Juvederm Ultra to add volume. New fillers continue to be developed which can also be useful. A softer filler is appropriate as lower eyelid skin is the thinnest in the body at 0.5mm of thickness, and can move flexibly with facial expressions – softer hyaluronic acid fillers don’t affect the appearance of the eyes like thicker filler or facial implant. The more malleable filler is also more easily molded and customized to fit an individual’s unique space under the eyes. The whole procedure, and any additional touch-ups can be performed in just a few minutes. Injectable cosmetic fillers like Restylane, Restylane Silk, and Juvederm Ultra typically last about 4-6 months, depending on how individual patients metabolize the material. Hyaluronic acid occurs naturally in the body, is safely metabolized with time, and is hypoallergenic.
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.
Platelet-Rich Plasma (PRP) for Under Eye Skin Discoloration and Thickness
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.
Why Fat Transfers are Not Recommended in Lower Eyelids
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.
Under Eye Hollowing can also be Caused by the Cheeks
Some cases of hollow under eyes, and asymmetry between both sides of the face may not be due to hollow tear troughs, but from volume deficiency in the upper cheeks. The upper cheeks can have a volume difference from natural asymmetry of one side from the other, or from volume loss due to aging. In such cases, adding volume with a filler at the tear trough may not be effective enough and can be problematic as there is no “shelf” of the upper cheek to support the volume.
Volume deficiency at the upper cheek is treated differently than the tear trough. Skin at the cheek is much thicker than thin eyelid skin, and the cheek is also backed by the more rigid cheekbone. A thicker hyaluronic acid filler such as Juvederm Ultra Plus or Juvederm Voluma can be used in the cheeks. These thicker fillers for the cheeks also last much longer than tear trough fillers – up to 1-2 years, respectively.
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.
With thicker skin in the cheeks, fat transfer or fat grafting is also an option to add volume. However, the nature of fat make it less predictable. A second surgical fat transfer procedure is likely needed due to natural absorption of the fat by the body. Also, the texture and shape inconsistency of fat. Fat grafting is also a complex and lengthy surgical procedure when compared to injectable fillers that can be done in minutes.
Fillers for Under Eye Bags
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.
Fillers can Treat Certain Cases of Eye Bags
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.
Fillers to Correct Volume After Eye Bag Surgery
It is crucial to sometimes leave or reposition some of the fat that causes puffy under eye bags. However, even if eye bag removal surgery was executed well, with good contour, adjacent areas may still appear hollow. Adjacent areas may include the upper cheeks (eyelid-cheek conjunction), or hollowness at the orbital rim of the eye socket. In areas where fat repositioning is not appropriate, an injectable filler can be used improve the hollowness. It can be a thicker filler at the cheek or a softer filler at the orbital rim and tear trough.Considerations for Eye Bags Surgery or Filler Treatment
Fillers are Not Permanent and Do Need Maintenance
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.
Injectable Fillers are as Invasive as Eye Bag Surgery
Many people choose to have cosmetic fillers to treat eye bags. Mostly because they want to avoid surgery, or because they want something that’s not invasive. Since dermal fillers are placed via injection that penetrates the skin, filler placement is an invasive procedure.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.
Recovery from Injectable Fillers and Eye Bag Surgery are About the Same
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.
Can under eye fillers go wrong?
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
Who is not a candidate for under eye filler?
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.
What is the best filler for under eyes?
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.
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Where to get under eye fillers?
To find the best treatment for your under eye problems, a proper physical evaluation is necessary. Contact us by filling out the contact form below, and we’ll get back to you. You may also reach us in Manhattan, New York City at (212) 265-8877. Or Garden City, Long Island at (516) 742-4636.