Thank you for your question.
You submitted your question with several photos.
And you state in your question that you’ve been booked for Restylane injection by a dermatologist
and that you went for a second opinion from another dermatologist and that dermatologist
told you that the risk for blindness from Restylane injection from this area, the tear
trough, is important.
As well as further describing that because of the thin skin and fat cheeks as described
in your question that you would end up looking like you had swelling or edema.
And so, there was no benefit from this doctor’s opinion, the second opinion.
And you state in your question that you can’t afford fat grafting and so you want to know
what you can do.
Well, I can certainly share with you my perspective on this 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.
Helping people with the under eye area whether it’s surgical for under eye bags as well
as the use of injectable fillers for the tear trough or under eye hollows has become a very
significant part of my practice and I have a lot of experience with this as well as dealing
with the complications of injectable fillers as well as surgery in this area.
Having an eye surgery background and understanding eye anatomy is relevant in this discussion,
first to address the risk of blindness.
So to begin with, there is a risk of blindness which has basically been described by the
placement of injectable fillers in this area as well as other several facial areas in the
medical literature.
And unfortunately is something that doctors do report periodically with some consistency.
But the risk is not only very low, it’s also very much has been associated with the
technique.
And as much as doctors get kind of sensitive about who has a better technique, I can tell
you that there are methods that lower the risk significantly.
So in my practice, when I place filler in the tear trough area, I routinely use something
called blunt cannulas.
And essentially, one of the anatomic issues with the placement of filler that results
in blindness is often the result of a filler being injected directly into a vessel that
will go back into the space where the vessels go into the eye.
So when you use a blunt cannula instead of a needle, you’re actually avoiding that
potential penetration of the vessel, not impossible but much less probable.
So I would not dissuade you from doing this because of the risk of blindness.
Now, as far as this doctor’s opinion about the potential for an edematous or swollen
look, there’s a certain degree of potential of that occurring.
We have seen many patients who had similar situations where in the valiant attempt to
help under eye hollows and to hide under eye bags, the person can look more swollen and
look like their bags are bigger.
But at the same time, there are certain ways to actually minimize that potential as long
as there’s clarity about the kind of outcome.
So if you have, on physical exam, very prominent under eye bags, well, then you’re more likely
to be a better candidate for lower eyelid blepharoplasty.
But if you have a minimal to moderate amount of fat prolapse and you have a relative hollow,
then fillers can be placed at the tear trough area and to soften and blend that area without
making you look swollen or edematous.
Again, it’s the art of the procedure, the art of placement.
It’s the art of choice and the type of filler.
And so that’s where different doctors bring different ideas to the table.
As far as your concern about not being able to afford fat grafting, well, this can be
in a way, in my perspective, a blessing in disguise.
I think that the fat grafting in the tear trough area, in my opinion, is not as predictable
and often results in irregularities and lumps.
So I actually dissuade you from doing fat grafting.
I would say meet with doctors.
And I think that if you really want to be cautious about the relative risk of blindness,
well it kind of stands to reason to go to somebody with an eye surgery background and
who understands eye anatomy.
This is where an oculofacial specialist, someone who is Board-certified or trained in ophthalmology
and then trained in oculoplastic surgery may be the type of doctor you will feel a little
bit more comfortable with if this fear of blindness is there.
Again, it’s also about the doctor’s experience and style and what methods they use.
As I said, I use blunt cannulas and I am really a cosmetic surgeon.
I routinely do this procedure and with that comes experience.
And so, you have an opportunity now to maybe meet with another doctor who is more specialized
in the eye area to maybe help you manage some of your concerns.
I would say respectfully, I disagree with the second opinion that you received and maybe
again, try someone who you will be more comfortable with this idea.
And as is the case for many things in this arena, you have to have a good meeting of
the minds between the doctor and the patient.
And for me, as a physician doing this for my patients, this is kind of a getting to
know the patient process where I see the patient, I follow-up in 2 weeks, I evaluate the results,
I compare the before and afters and my patients and I get to have a longstanding relationship
so that I am able to do things with some consistency for them.
So I hope that was helpful, I wish you the best of luck and thank you for your question.