Thank you for your question.
You submitted your question with a single photo with an arrow pointed to your area of
concern.
And you’re stating that the under eye correction that you had with a filler is unequal and
your doctor is unable to fix it.
And so you’re looking for guidance as to what to do to help your current situation.
Well, I can certainly share with you my approach to patients like yourself of course without
the benefit of other views and of course a physical examination but I can certainly give
you a perspective that I help counsel my patients on and dealing with type of issue.
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.
And helping people with the under eye area whether it’s puffiness, hollows as well
as facial aesthetics both non-surgical as well as surgical solutions has been a big
foundation of my practice for now more than 2 decades.
So I’ll share with you first how I counsel my patients when I evaluate them for rejuvenation
in this area.
To begin with, I take photos, from the front, 3 quarters views and side views and help patients
understand that when they look in the mirror and they see a hollow under the eye, well
very often, it’s also in the context of the face also having relative asymmetries
in terms of the relative prominence and projection of the cheekbones.
And that’s a very important factor.
Because when I look at someone, when I look at the eyes, I just don’t look at the eyes.
I look at the eye as they relate to the cheek area and this can be very helpful in planning
a strategy that can optimize the rejuvenation.
So when I look at your face and the area where you point the arrow where you’re concerned
about the asymmetry and the indentation, I would also point out that the cheek area,
the eyelid to cheek junction, there’s less volume as well as maybe some less volume in
the most prominent part of the cheek on that side called the malar eminence.
So I help educate my patients about this because when you do a filler like Restylane in the
tear trough which works extremely well, if there is no support in cheek volume, then
it’s like sitting on a ledge and you can have these elevations, relative indentations.
So what I frequently do is I combine the filler under the eye with a filler on the cheeks,
again, looking at the eye and cheek as one continuous area.
Now we use a method called Structural Volumizing for the cheek area and this is important because
when you think of what we’re correcting, we’re trying to correct the volume at the
bone level.
It’s also important to correct volume at the deeper fatty compartments of the cheek
as well.
This way it looks more natural and it blends as if without creating surface irregularities
and not looking overdone.
Now that’s the art of doing this.
Now that’s a suggestion for you to explore is that not to necessarily just keep adding
volume along this rim but to also consider augmentation in that cheek area to balance
out with the other side.
There is nobody who has a perfectly symmetric face and that’s just what I explain to my
patients is that we’re beautifully imperfect.
However, it’s understandable that if there’s an obvious difference that’s drawing the
attention of people around you but that’s not productive.
You want to try to do something about that.
If your doctor is unable to assist you with this, find a cosmetic surgeon, someone who
knows this area very well who does a lot of fillers at the under eye area and the cheek
area.
Like I said, in terms of technique, there are many different ways to do these injectable
fillers.
And I feel, of course, the way I do these procedures with blunt cannulas and my understanding
of anatomy as a surgeon has given me a certain perspective that’s different than someone
who hasn’t operated in this space, people who are coming from, let’s say, superficial
level not naming specific specialties directly.
But certainly I feel like, from my perspective as a surgeon, I think that Structural Volumizing
and these compartments around the eyes, I have been definitely been successful with
this.
And I think that is a key to helping you maximize the symmetry that you’re trying to seek.
So again, meet with qualified, experienced doctors in this area and learn about your
options.
And I think that you should be able to get an improvement.
You may need to dissolve a little bit but I don’t think it’s likely that it would
be necessary.
But certainly, the key is to have balance as good as possible and to understand.
I guess the take home message here is, understand how the eyelid and cheek are really connected
and how enhancement can really create a more balanced appearance.
So I hope that was helpful, I wish you the best of luck and thank you for your question.