[Music] Are tear trough implants a permanent solution for hollow eyes we routinely see
patients complaining of under eye hollows and dark circles I generally address this
issue with hyaluronic acid fillers as well as PRP or platelet-rich plasma this modality
has been a major advance in my ability to help a wide range of patients who did not
have this option many years ago interestingly patients do offer inquire about permanent
options such as permanent fillers fat grafting and facial implants such as a tear trough
implant prior to the introduction of hyaluronic acid fillers I did perform placement of fat
grafting as well as silicone tear trough implants so I can provide some perspective for those
who are experiencing filler fatigue I'm Dr. Amiya Prasad I'm a Diplomate of the American
Board of cosmetic surgery and a fellowship-trained oculofacial plastic and reconstructive surgeon
I've been in practice in New York City and Long Island for over 25 years let's start
with the subject of permanent fillers permanent fillers such as injectable silicone PMMA or
calcium hydroxyapatite are difficult to impossible to fully remove if there were to be an infection
or a foreign body reaction in contrast hyaluronic acid can be reversed with the placement of
an enzyme called hyaluronidase as far as fat grafting is concerned in our field fat grafting
has been considered the ideal filler since most people have some fat that it can be harvested
in quantities far greater than what is typically used when placing injectable fillers unfortunately
particularly in the under eye areas fat grafting can be problematic the term graft means that
there is no blood supply and there is a reliance on the tissue where the fat is transplanted
to to provide a blood supply so that the fat would survive this is a problem since some
of the fat may survive while other grafted fat will not this can result in surface irregularities
and cosmetically undesirable outcomes I'm routinely seeing patients from around the
world who come to me to have me surgically remove these fat grafts from underneath their
eyes this procedure can be technically challenging and potentially requiring multiple procedures
in order to maintain proper eyelid support and function predictability of outcome is
very important and most people who I see have limited time and tolerance for unanticipated
issues in the early years of my career I performed a lot of facial implant surgery including
the placement of silicone tear trough implants we have learned more over the years in that
although the implant itself will remain intact there are significant changes that occur with
normal aging affecting the bone structure and overlying soft tissue so although the
implant may be permanent the human body continuously changes this means the implant is not truly
a permanent solution since it does not change with your body I have been very impressed
with the application of facial implant principles when using hyaluronic acid fillers although
there is often a lot of interest in the names and types of hyaluronic acid fillers that
are on the market cannot emphasize enough the importance of technique anatomically speaking
I generally Place hyaluronic acid fillers with different viscosities at the bone level
in areas such as the tear trough cheekbones chin and jaw angles in doing so the fillers
typically will actually feel like bone we refer to this approach as Structural Volumizing
I perform these procedures in my exam rooms with blunt cannulas thereby reducing the risk
of bruising or vascular complications associated with only using needles our patients often
have these procedures done during their lunch hour and are able to go right back to work
hyaluronic acid fillers are safe and metabolized naturally by the body and when placed with
this technique have a tendency to last a very long time although they are not permanent
the placement of these fillers with syringes and cannulas allows for very accurate adjustments
in a way that permanent implants such as a tear trough implant cannot be done at this
time as a surgeon I am delighted to perform these procedures safely predictably and with
the option of reversibility while getting results that appear as if surgery was performed
I hope you found this information from my experience helpful if you are interested in
recommendations for your individual situation you may contact our offices through our websites
or call to schedule a consultation thank you [Music]
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[Music] thank you