Thank you for your question!
You’re 58 years old and you described in your question in the question you submitted
a series of challenges you’ve had with injectable hyaluronic acid fillers in the eye area to
help the appearance where you’ve had a couple of challenges such as getting an injection,
having it dissolved, getting another injection and now you’re dealing with this kind of
appearance of malar bags and you’re asking about augmentation in the adjacent area.
Well, certainly I can assist you with this question.
I’m a board certified cosmetic surgeon and fellowship trained oculofacial plastic and
reconstructive surgeon practicing in Manhattan and Long Island for over 20 years.
Hyaluronic acid fillers are a big part of what I do to help people with the appearance
of their eyes and their face.
So I can certainly recognize very well your frustration and it is something that you are
in good company with because a lot of people have gone through exactly what you are going
through right now.
You see, the challenge with fillers and I think one of the challenges that is kind of
not appreciated by particularly doctors, let’s say skin doctors or dermatologists or non-surgical
physicians, is the concept of volume correction in soft tissue.
The reason I’m saying that is that in theory, the idea of filling where there are hollows
makes sense but what is limiting a lot of times is the structural and integrity of the
tissue.
There are several dermatologists in our city in Manhattan as well in Long Island who believe
that a youthful appearance is smooth skin and they plump people very aggressively.
And unfortunately, that makes people look soft and lumpy and irregular.
Now the point of saying that is that what they didn’t appreciate is that the person’s
skin can’t take that much and the material doesn’t stay in a way they want in the volume
and in the configuration that they want.
So that leads me to thinking about this in a more global way.
When you understand that at 58 and with your skin type, you’re dealing with certain elements
of facial aging.
The big element that is significant for you is volume loss and volume loss begins at the
structural level at the skeleton.
So bone, muscle fat, soft tissue is diminishing.
So I think you’re at the right track and what I would probably do to assist you or
assist someone like you in my practice is I would consider a method of using the most
solid structure on the face which is the bone structure and the soft tissue overlying the
bone which is mostly muscle to provide you with volume and the concept is structural
volumizing and the method that we use is called the Y lift.
Y lift is a method where we apply the same hyaluronic acid fillers but as opposed to
putting it just below the skin to try to camouflage and soften transitions of volume loss, is
actually placed under the muscles.
Now this is a method that is very specific and very elegant and very effective.
What we are able to do is restore cheek volume and jawline and structure in a more global
way.
And if you think about, when you have structure everywhere else that’s more defined then
the under eye areas of hollowing become less of an issue and you can be conservative and
put smaller volumes to correct the areas that you’re interested in.
When I look at your photos, I notice these kind of wedges of materials and that’s created
not only the volume but probably fluid is being attracted to these areas and resulting
in swelling.
So if you think about it, there is really a lot of opportunity to try something a little
bit different because invariably, you’ve tried something different using conventional
thinking where one doctor thinks “Well, maybe it wasn’t the hyaluronic acid that
was used prior.
Let’s use something different.”
Or they think “I’m really good at this.
I’m going to inject this at just the right place in the soft tissue.”
But in the end, I think it’s a structural integrity issue and I think there’s an opportunity
here.
With Y lift and structural volumizing, restoring youthful structure actually diminishes the
need to micro manage the areas that we typically think of when you think of facial aging whether
it’s hollow or lines.
You know, the tradition of fillers in facial aging is to chase lines.
With structural volumizing, what we’re doing is restoring structure.
So I think that without getting more to more unnecessary details, I think that you’re
in the right track.
I think that there’s an opportunity to try something that is a little bit different but
at the same time, the value of using a hyaluronic acid filler, as what you’ve already experienced,
is that it can be dissolved.
I think that you’re going to get a lot of ideas of different methods, different fillers
that are going to be at the skin level and what I’m talking about is really below the
muscle level where the muscle combined with the skin, provides a much better balance to
this material that can be placed just over the bone structure and give you back the definition
that is more youthful.
So I hope that was helpful, I wish you the best of luck and thank you for your question!