Loss of volume in the face is normal part of facial aging.
Loss of volume can also be the result of surgery and thermal energy devices used for skin tightening.
This hollow look can leave eyes looking tired and weary, and even make the eyelids look
droopy.
In this video, I’ll discuss how addressing this hollowness can be achieved with a minimally
invasive procedure that doesn’t require surgery.
I’m Dr Amiya Prasad.
I’m a Board Certified Cosmetic Surgeon and Fellowship Trained Oculoplastic Surgeon.
I’ve been in practice in Manhattan and Long Island for over 20 years.
Cosmetic eyelid procedure, from cosmetic upper and lower blepharoplasty, Asian double eyelid
surgery, and ptosis surgery are at the core of my practice.
As an eyelid specialist, I also perform revision and restoration work to correct eyelid surgery
originally performed by other doctors, with patients coming to us from around the world.
I have found that having surgical expertise with eyes especially complex cosmetic reconstructive
surgery including use of grafts and bone repair has informed my approach to the application
of injectable fillers.
As a teaching doctor, I’ve recognized the different levels of understanding of this
complex area between medical practitioners and I strive to educate colleagues to understand
this area to avoid potential complications.
Many people would assume that correcting upper eyelid and brow hollows would require surgery.
While there are surgical options, which in the past was the only way to treat these types
of hollowing, the introduction of a range of hyaluronic acid fillers has made this area
amenable to non-surgical treatment.
Surgical options for this procedure include modalities such as fat grafting.
In my experience, fat grafting has limited application and I do not recommend it for
thin eyelid skin.
The thicker skin of the lower brow area can be suitable for fat grafting.
Fat grafts can be placed below the brow and the hollow space above the eyes and this approach
has worked out well for many patients.
The issue patients can have with fat grafting is that it is a more complex and involved
procedure, and can be more costly.
Fat grafting is a two step procedure: Fat is surgically harvested from elsewhere in
the body, such as the abdomen with liposuction It is then processed and then surgically placed.
Drawbacks of this procedure is the predictability of the outcome and the time for healing.
30-70% of fat grafted into an area can be absorbed by the body or heal in an unfavorable
way resulting in irregularities.
I explain to patients considering a fat grafting procedure to be prepared to have at least
two procedures.
Significant swelling after surgery can last for months and even past 1 year.
In my practice, I typically recommend a procedure which is more convenient and predictable for
the patient.
This procedure involves the use of a filler in the hyaluronic acid family such as Restylane
or Juvederm.
This is where knowledge and surgical experience in the eye area is very useful.
Every part of the area below the brow has specific anatomy which is important for proper
filler placement.
For example, there is a space between the center of the brow where filler can be placed
just behind the brow skin where the filler can be placed in a manner where the material
can be stable and make a significant impact for hollowing, eyebrow position and eyebrow
shape.
I perform this procedure using an instrument called a blunt-tipped cannula instead of needles.
The techniques I use typically results in no bruising with minimal swelling.
The hyaluronic acid filler placed in this space can last from 6 months to up to a year
(and sometimes even more), depending on the individual.
It’s been my observation that fillers do last longer in this space when compared to
other areas such as the lips.
It’s important to understand that maintenance is needed as fillers are safely broken down
by the body.
Healing and recovery is typically minimal with people often returning to work right
after the procedure.
Even though bruising and swelling is minimized with my use of cannulas, some limited bruising
is possible which usually resolves within a week.
I see my patients for all cosmetic filler procedures after two weeks to see how the
filler has settled, and to make further enhancements if appropriate.
Attending an event soon after filler treatment is quite possible, depending if any slight
bruising from the injections are still present, but even these should be minor and covered
by makeup.
This is in contrast with fat grafting, where patients would likely need to wait at least
a couple of weeks due to swelling and bruising.
After filler treatment, appearance is generally stable after the two-week follow up.
The use of cosmetic fillers makes correcting brow and eyelid hollowing much more convenient
and predictable than fat grafting surgery.
Patients who undergo filler treatment can go back to their daily routine almost immediately,
and come for follow up and have maintenance visits on a regular basis.
In my opinion, the convenience and predictability of fillers makes them the optimal choice for
upper eyelid hollowing and brow volume loss.
I hope you found this information helpful...thank you for your question