Spot On Eyelid Rim

How to Treat Under Eye Indentations Dark Circles with Fillers and PlateletRich Plasma

I have dark circles (hereditary) which isfine, I can live with that. How do I get rid of the indentationsé These indentations left after makeup applicationare killing me! I look old and tired when I'm not! What can I do about themé Thank you for your question. You've submittedthree photos and a straightforward question about dark circles under the eyes which ishereditary and you're concerned about what you described about indentations and the differentangles of the photos I believe basically you're concerned about the area we refer to as thetear trough.

So I think that most people who work in thisarea will agree that you'll probably a good candidate of some type of filler that is hyaluronicacid filler. I'll let you know a little bit about what we do in our practice, I'ma cosmetic oculofacial plastic surgeon and we actually combine the hyaluronic acid fillerwith something called platelet rich plasma. This was a kind of serendipitous discoverya few years ago when patients of ours who had aged appearance to the skin who also hadthe dark circles actually had an improvement in the skin quality of the dark circles evenif they were genetic and that is because when eyelid skin is affected by aging or environmentalchanges or for someone who wears make up and

then aggressively takes off that makeup. Thechemicals used to wipe off the makeup can often dry out the skin and actually acceleratesome of that aging appearance to the skin. So what we have been doing is we've actuallybeen doing a combination approach of hyaluronic acid filler such as Restylane to provide somevolume to fill that area in the tear trough and as well as the area of the orbital rimor the rim between the eyelid and the cheek we call that the eyelidcheek junction. Thattypically will provide some volume and then we combine that with platelet rich plasmawhich helps skin quality. There have been studies done on wound healing were the combinationof hyaluronic acid with platelet rich plasma

actually resulted in improvement in woundhealing and it has been our observation that we actually are very pleased with the qualitativeimprovement in the skin and the area. So I think that a challenge that you are goingto face when you do decide to try this is that hyaluronic acid can be a little bit challengingtechnically for both the physician performing the procedure as well as for the patient whois undergoing the procedure in that very often the correction can be too little, too muchor creates some irregularities and bumps. So you just have to be committed to work throughwhatever challenges there are. Once the material is placed and it looks good and the way Iapproach it is that I spend a lot of time

on every patient where I'll put a littlebit, I'll mold it and I'll come back to the patient after a few minutes to see howit looks. But once it's done and it looks good it could really look very very nice andit can make a real improvement. It does require maintenance however there's no permanentsolution although there are some s who recommend fat transfer and other things thatare involved; surgery or grafting a tissue it' been my experience that eyelid skinis very thin and does not do well with fat grafting. I think it just very often resultto irregularities and bumps and we have patients who come from all over the world for me toaddress fat that did not work out so well

and they actually need more extensive surgeryto actually remove and reconstruct the tissue. As far as hyaluronic acid is concerned, inaddition there is a safety mechanism associated. It turns out that we actually have an enzymecalled hyaluronidase which can actually melt the hyaluronic acid. And I'm stating thatbecause we also get referrals for patients who have excess hyaluronic acid under theireyes and so they often come to us to start clean and we end up actually dissolving it. So just be aware when you are doing your consultations.Meet with s who have a lot of experience with dealing with dark circles and hollowedareas and with hyaluronic acid and there are

Why Volume Loss in the EyelidCheek Area is Likely Caused by Aging and not by Previous Surgery

Hollowing after eyelid surgeryé If I can't use facial fillers, what are theother options I have for these results after eyelid surgeryé I'm 5 months out now and thesunken look seems to be getting worse as time goes by. Thank you for your question! It's five months since you had your eyelidsurgery and you're very concerned about the hollowing of your lower eyelids. the photosyou submitted have been very helpful because you submitted different pictures in differentlight. I'll share with a little bit about

my approach to addressing what is often perceivedfirst as hollowing under the eyes. Well, not seeing your preoperative photos, assumingthat you had significant amount of puffy bags under your eyes that you need lower eyelidblepharoplasty. I can also tell you that the lower eyelid position looks very good. I thinkthat the goal of the lower eyelid blepharoplasty was essentially accomplished which was totake away the negative of the bulges of fat underneath the eyes. In my practice, I first give the patient ageneral overview of the overall changes. I wrote a book a few years ago called quot;The FineArt of Looking Youngerquot; and it was based on

the idea that people need to understand thatfacial aging or genetic changes are a combination of volume loss and sagging or descent. Veryoften if someone comes in and has bags under their eyes, if they happen to have cheeksthat look flat or there's a lot sagging, I bring to their attention that the area oftheir eyes do not change in isolation. This is an exception when we talk about somebodywho is in their 20s or younger. But for a lot of people who come for this procedure,who are in their late 30s or beyond, volume loss is a very significant part of the overalllook of the person's appearance. The challenge is, if we a problem such asbags under the eyes, we focus on that and

we literally magnify it and we don't lookat anything else. So what I do is that I bring this to the attention of my patient and explainthat if after the surgery, if they have any concern about relative hollowing under theeye, we would address certain key anatomical elements that are associated with the perceptionof hollowing. These elements include the tear trough area and that area is very importantwhen it comes to the overall appearance of the eyes look good. The area of the eyelidcheekjunction sometimes called the Vdeformity and that's at the rim at the lower part ofthe eyelid. When we are younger that area has a volume and has layer of fat and a littlecushion there. Genetically when people are

young or with age, that area becomes depletedand you start to see an effacement or an revealing of the bony structure. And there's the malaror the submalar space. Those areas can be very flat. So my typical strategy for the tear trougharea and the Vdeformity area is combine hyaluronic acid such as Restylane with plateletrichplasma. Plateletrich plasma is derived from your own blood. It is blood that is spun downlike from a typical blood draw when you do in a lab. We spin the blood down and we concentratethe platelets and the growth factors that are responsible for healing. We have seena very nice synergy in the quality of the

skin, the volume correction and the overalllook with this combination of hyaluronic acid with plateletrich plasma. Certainly hyaluronicacid alone is a perfectly good filler. Very often our patients are little frustrated todo this as maintenance but when you are dealing facial changes, not everything is surgicallycorrectable. That's why there's role for fillers and other things to correct volume. In themalar and submalar area, we can do things such as fillers such Radiesse or fat transferas wells as more permanent procedures such as placement of submalar implants. Every patient has to be evaluated individuallyand there has to be communication to get a

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