What is the best treatment for my under eye?
My under eye circles and hollowness came on within the last 6 months.
What direction should I go that will give me the best results?
Thank you for your question!
You submitted a single photo showing both eyes and you are concern is about hollowness
and dark circles that have appeared over the course of the last 6 months.
Well, looking at this photo, certainly I can appreciate what you’re describing.
I think the majority of your concern is in the area we refer to as the tear trough.
In addition, there’s also an area adjacent towards to the center of each eye which is
called the V deformity or the junction between the eyelid and cheek where as we get older,
we lose some volume.
In your right eye, you appear to have some puffiness in your outer aspect but this may
be an artifact of the photo but in terms of addressing relative hollowness of the eyes,
we can certainly share our approach in our practice.
I’m a cosmetic oculofacial plastic surgeon.
I specialize in eyelid surgery and eyelid rejuvenation and practicing in Manhattan and
Long Island for over 20 years.
This time in the medical field is an exciting time because we now have more options that
we used to for dealing with this volume loss.
So in our practice, our approach is to address volume with a filler such as hyaluronic acid.
Hyaluronic acid comes in many different brand names including Restylane, Juvederm and can
really be very effective in restoring contour in the really delicate area.
The trick is to be able to place the material into the areas that need to be placed and
avoid lumpiness, irregularities and swelling.
A lot of times, people get a little bit ambitious and they fill more and they make the eyes
look more puffy.
So there’s an art to that.
And with that placement, you can really get significant improvement.
The way the skin of the eyelid, the thinnest skin of the body, just rests against the bone
when there’s less tissue between, it just makes the area very dark.
So a filler is a great solution and is worth exploring.
The downside of fillers is there is maintenance involved.
And a lot of times, people want to go for something permanent such as something like
fat transfer.
From my perspective, I have not seen very good results from fat transfer.
Fat grafting unfortunately, does not really apply uniform filling and a lot of times,
people can get irregularities and lumps.
People come to us from all over the world who have had fat grafting and we actually
remove the fat because they creates these irregularities and problems.
So I tend to not use it.
I like to do things that are more predictable and are able to really minimize the patients
down time.
In a world where everybody’s busy, prolonged swelling is not acceptable in any reason.
The other thing that we also do that is also unique is something called platelet-rich plasma
treatment.
Platelet-rich plasma or PRP is derived from your own blood.
And what we are essentially doing is concentrating the platelets and growth factors necessary
for wound healing and applying them under the skin.
And what we have seen is improvement in color and quality and just overall health of the
skin.
in fact, when we use PRP in the rest of the face, whether it’s for acne scars or just
for complexion improvement, the patients always come back with this nice glow because it stimulates
blood supply and this is something that makes it really different from fillers.
So our approach is to apply a synergy in this area.
We do a filler for the volume and PRP to improve the skin quality.
And we have had a very high level of satisfaction from our patients.
We follow our patients closely to make sure the contour and shape is really nice and we
always tweak if necessary.
Again, this is an art and it has done artfully.
A lot of people try to differentiate themselves saying they use different tools such as blunt
cannulas and other things to minimize bruising and certainly, that’s respectable and it
depends on the hands that use the instrument.
But there’s an art and getting the material in the right place in the right volume and
getting the right shape is artistic.
So I can’t drive that point home enough.
But the synergy with platelet-rich plasma has been very effective.
Now these fillers can last anywhere from 3 months, 6 months and even up to a year and
even sometimes beyond.
But it is individual so you have to kind of see what works for you.
It is very common or patients to ask give me the longest filler.
But very often, the longest lasting filler may be too thick to use in this area so there’s
always some type of customization that has to be part of this and acceptance you’ll
need to do this on some kind of regular basis.
Facial aging is volumetric loss, loss of bone, muscle and fat, so restoring volume strategically
and keeping a natural look is important and is a commitment.
So with that being said, I hope that was helpful, I wish you the best of luck and thank you
for your question!