Thank you for your question!
You stated in your question, that you submitted without a photo, that you’re going in for
your routine Juvederm injections and you’re interested in options for under eye hollow
treatment and you understand that Restylane is popular.
And you say that you have very slight hollows.
So, certainly I can give you some idea about how I approach people who have these types
of concerns when they come to my practice.
To give you a little bit of background, I’m Board-certified cosmetic surgeon and Fellowship-trained
oculofacial plastic and reconstructive surgeon specializing in cosmetic and reconstructive
procedures of the eye area.
So understanding that with many different options when it comes to the perception of
under eye hollowing, we have to define what is the cause of the under eye hollow concern.
For example, it is very common for people to feel that they have a hollow when they
also happen to have puffiness.
There’s a difference between puffiness and hollowing that you need to make sure to understand
before going in so that you make an informed decision.
When we talk about under eye hollowing just alone and this is in the absence of puffiness,
we are dealing with basically loss of volume in the area of the tear trough and the eyelid-cheek
junction.
In this area, it is routine for me to place Restylane.
Restylane is a softer filler, a hyaluronic acid filler.
I often combine it with platelet-rich plasma (PRP) to help the skin quality because very
often, people who are concerned about under eye hollowing are also concerned about the
dark quality of the skin, the thin quality of the skin and often, there’s sun damage
and other issues.
So the filler can be placed very strategically and used to improve the under eye hollowing.
Now what happens when you have puffiness?
Well, if it’s a minimal amount of puffiness, you can still get away with placing a bit
of filler.
What’s interesting is, a lot of times, people really over interpret what they consider as
a minimal amount of puffiness.
We have patients who have very large bags under the eyes, come to the office and say,
“Can you put filler to deal with the hollows?”
Now when I show them what the puffiness is which is, for your information, is lower eyelid
fat prolapse which means the fat around the eyes pushes forward and creates a bulge and
that bulge acts like a mountain which makes the adjacent area look hollow.
So they learn that if the puffiness is too big, then the under eye hollow can’t be
improved with filler.
And I tell you, as a specialist in oculofacial cosmetic surgery, patients come to me from
all over the world with filler issues related to trying to hide under eye puffiness as well
as to address under eye hollows.
Well, what we end up doing is using enzymes like hyaluronidase to melt away this material
to get rid-off this excess volume.
So you have to be careful about making this decision about filler.
Less should be just enough.
If you’re putting a lot more filler, you have to ask yourself what you are really addressing.
Are you dealing with a deep under eye hollow or are you dealing with cheek volume loss,
are you dealing with really lower eyelid fat prolapse or puffy under eye bags?
So in addition to the hollow issue as well as skin quality from a thickness issue, we
also deal with helping people with discolorations under the eyes.
And sometimes, a little bit of laser, whether it’s a fractional laser or an ablative laser
or even a light peel or even something minimal like the use of topical retinols can help
the under eye hollow appearance.
So speak to your doctor who you’re going to for routine Juvederm and ask about these
options.
Learn about what makes sense for you.
Try to make sure you are able to distinguish what is hollow and what is puffy and then
move forward.
I think that Restylane is a very good option for this type of situation because we have
a lot of experience with that.
We use blunt cannulas and place the material in a way to minimize the trauma and improve
the area and it can be interesting.
The material can actually last a lot longer than it does in the dermis but that’s a
separate discussion.
So I hope that was helpful, I wish you the best of luck and thank you for your question!