Thank you for your question.
You submitted your question with a photo.
And you state in your question that you want to know what the fine circle around your eye
socket is called and how do you go about erasing it.
Well certainly, I can share with you how I approach patients in my practice who share
similar concerns as yours and explain what the different issues are that cause and create
this type of appearance.
A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon.
I have been in practice in Manhattan and Long Island for over 20 years.
Helping people with the under eye area has been a significant part of my practice.
And I have developed a lot of different strategies to help my patients based on an evolution
technology as well as greater knowledge about this particular area.
So it is important to have a sense of understanding about what is causing the line and what the
options are to improve this.
So to begin with, one of the critically important things to understand is that with facial aging
comes a significant amount of volume loss.
And volume loss means that there is a decrease in the bone structure particularly in this
area, the eye socket called the orbit.
The orbit and the cheekbone, the zygoma, are very important in their relationship.
So as there is volume loss, so loss of fat, loss of muscle, loss of the soft tissue, the
fat under the skin and the skin itself also gets thinner.
In a way, sometimes it’s referred to as a skeletonization and you start to see some
of the underlying structures.
So when you see this line, essentially what you are referring to is a ligament that connects
the skin to the eye socket.
And when we look at the area, when we as a physician look at this area, I think it’s
less productive to chase lines.
Essentially in many ways, the gold standard of wrinkle treatment has been to erase wrinkles.
And so whether it’s with creams or with lasers or with injectables, there’s always,
“chasing the lines”.
What I think is more relevant and you can look at people who are considerably younger
is that they have similar issues.
There is an important understanding and balance to facial harmony.
And what I mean by that is when you look at your eye, I would say look at the eye and
the cheek together.
When you look at the eye and cheek together, there are certain things that you can notice.
One is you might be able to appreciate that above that line is a little bit of puffiness
which means a little bit of the fat that is normally around your eyes that is pushing
forward.
That’s called lower eyelid fat prolapse.
Below the line, the cheek volume may be also diminished.
And so there is often a strategy that I would recommend with my patients that, depending
on what they look like in 3D, three dimension in front of me which is something I can’t
necessarily comment on in that opportunity is basically, you look at different angles.
When I do an analysis in my practice, I take pictures from multiple angles so patients
get to see what they look from angles they don't usually see when they take a picture.
When they take their own picture, they are usually smiling, they are usually posing.
When you’re taking medical photography, you’re taking photos of faces at rest and
with specific movement if those movements are relevant.
So opportunities may exist such as the placement of fillers in this area to help improve the
valley next to the elevation of the fat pockets in an area where we often refer to as the
tear trough to orbital rim area, we can use fillers.
Fillers are usually in the hyaluronic acid family.
An important caveat is that placing fillers just in the edge there may soften that line
but it will not make you look significantly better.
This is where we suggest to a lot of our patients to consider procedures such as Structural
Volumizing.
Structural Volumizing is a very specific technique on using a thicker hyaluronic acid filler
such as Juvederm Ultra Plus or Juvederm Voluma.
By placing it at the bone level between the bone and muscle and restoring volume in the
cheek, you really create a very natural projection that very often contributes significantly
to improvement in the eye area.
We have to always think not only specifically and zone in an area of concern but look at
the face in the whole context and look facial harmony and balance.
So I would say that there is certainly a lot of options beyond just fillers.
There are ways to also improve skin quality be it with lasers or with emerging or significant
technologies in regenerative medicine such as platelet-rich plasma (PRP).
So I think it’s important you meet with qualified, experienced, cosmetic surgeons,
physicians who really work a lot in this area who understand what it is you are concerned
about.
I find that a lot of patients come in who are essentially unsure on why they went to
a doctor, got a filler in the place they wanted and yet dissatisfied.
And I would argue that it’s about harmony.
People want to look better.
We as human beings, we identify certain lines or characteristics more globally, then you
can really create a lot more of satisfaction by understanding the relationships that can
actually help you look better without just addressing individual lines.
So I hope that was helpful, I wish you the best of luck and thank you for your question.