Fillers for Lower Eye Bags & Dark Circles
Fillers are a minimally invasive facial treatment that have really changed the way we temporarily treat lower eyelid bags and dark circles. Since I started my practice more than 10 years ago I’ve seen a significant change in how we treat these problems. I’ve done thousands of fillers for lower eyelids and these are some of the most important things I’d like you to know before you let anyone inject anything around your eyes.
- Who is qualified to inject my lower eyelids and why do I need to see a specialist?
- What are different types of fillers and what are the best to use around the eyes?
- How long do most hyaluronic acid fillers such as Belotero and Restylane last around the eyes?
- Can my own fat be used as a filler?
- Who is a candidate and who is not?
- How is the procedure performed?
- Why do you use a blunt needle rather than a sharp one to inject the fillers?
- Chronic fluid retention syndrome, also known as chronic eyelid swelling, after fillers?
- What is the Tyndall effect after fillers and how can it be treated?
- Can fillers affect future surgeries?
- What are the costs of filler injection around the eyes?
- OK I want to know if I’m a candidate, how should I proceed?
This is probably one of the most important questions you need to ask yourself when it comes to your eyelids. The tissue around the eyes is very delicate. What amazes me is that today we have many different “injectors” who are nurses, dentists, physician assistants, family physicians, dermatologists and even general plastic surgeons who take a weekend course and, without understanding the delicate eyelid and periocular anatomy, start injecting patients. This may sound OK to you but we are seeing an epidemic of problems occurring that didn’t exist before. These problems happen because 1. the wrong product was injected, 2. the right product was injected to the wrong place, 3. the wrong patient was selected for the injection. The person who should inject you should be an expert in the eyelids. Start by looking for an oculoplastic surgeon who does a lot of cosmetic eyelid procedures and has experience with injectables.
As we age we lose volume around our face and soft tissue around our eyes. Think of a grape that shrivels with time. Fillers replace the volume in the soft tissue. The hyalauronic acid family of fillers such as Restylane and Belotero are my two favorite minimally invasive procedures. In general, I do not recommend injecting Juvederm products around the eyes as they are very hydrophilic (love water) and this causes a lot of chronic swelling.
I would say on average most HA fillers last about 1 to 1.5 years. But I have seen cases where they last much longer.
Yes, if a patient is having eyelid surgery with me and they have more than 20% volume loss around the face (which is basically anyone over the age of 50), I usually liposuction a small amount of fat from the belly and reinject the fat into the face with small blunt cannulas. This procedure requires anesthesia and is only recommended for patients who are interested in a longer term surgical solution.
First of all, again it must be clear that fillers are only a temporary solution to lower eyelid bags and dark circles. An oculoplastic surgeon specializing in cosmetic eyelid procedures should be able to tell if you are a candidate for fillers. Typically, patients who have more volume loss (hollowness) around the tear trough are better candidates. If you have puffy lower eyelids, then you are not a candidate for fillers as this will make the puffy eyelids worse. This includes patients who have chronic allergies in their eyes. Unfortunately, I’m seeing a lot of patients that are not the right candidate getting fillers which makes the whole situation worse.
The skin around the eyelid is numbed using a cream for about 10 to 15 minutes. The area is then cleaned with alcohol. The filler is injected using a blunt needle.
In my experience the best and safest needle to inject around the eyes is a blunt needle. There are a few reasons for this. 1. reduced risk of bruising, 2. reduced pain, and 3. better anatomical contouring and product placement.
This is becoming one of the biggest reasons I’m seeing unhappy patients for consults these days. This condition happens when either the wrong filler is injected by an unqualified physician to a patient who doesn’t need fillers or too much is injected. Most of these patients complain of having episodes of on and off swelling of the eyelids. The only way to treat these patients is to get rid of the filler. Typically, these patients need several injections of Hyaluronidase, which helps dissolve the product, separated by two or three weeks. As you can imagine the deflated skin now needs to be tightened either by surgery, co2 laser resurfacing or radiofrequency. Most patients are happy to just get rid of the fillers.
The Tyndall effect, also known as Tyndall scattering, is light scattering by particles in a very fine suspension such as a filler. These patients complain of a light blueish color on the superficial skin where the filler was injected. Typically, patients who have very thin skin or have had the filler injected too superficially can get the Tyndall effect. In some cases, the condition resolves by itself as the body absorbs the product. However, in cases that it doesn’t, I recommend removing the product.
Most fillers don’t last more than a year, so in theory they don’t really cause problems with surgery; however, I’m seeing patients who have had Juviderm fillers placed around the eyes and if they are not removed prior to surgery they can cause severe post-operative swelling.
The cost depends on the type of filler used. The price for HA fillers around the eyes is between $800 to $1500 per syringe.
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