Would I benefit from Botox and perhaps fillers for under eye area?
When I smile I have these ugly lines under my eyes also when my face is resting I'm starting
to get fine lines.
My goal would be to have them gone and not so dramatic when I do smile.
I also plan on getting fillers in my cheeks do you think this would help with my eyes
creasing as well?
Thank you in advance.
Thank you for your question!
You submitted a single photo and your question covers a lot of areas, focused on the area
around your eyes.
You’re describing lines that occur when you smile, the lines that are there when you’re
at rest.
You’re considering some injectables for your cheeks and you want to know if that will
help your under eye area.
And you started the question about Botox.
Well, this is certainly an area that we are very familiar with in our practice.
Just to give you a little bit about my background, I’m a board certified cosmetic surgeon.
I’m fellowship trained oculofacial plastic surgeon.
That means my background training was first in eye surgery before I did super specialty
training in cosmetic and reconstructive surgery of the eyes and the face.
And so, aesthetics of the eyes is extremely important in our practice and is something
that we really deal with a lot in our practice in Manhattan and Long Island for the past
20 plus years.
So to begin with this discussion, it’s important to get some definitions.
So with the definitions, you can then define the solutions.
So you describe the lines that form when you smile.
What does that mean?
It means that there’s muscle activity that causes these lines to form.
Now the term for that is dynamic lines.
You also mention lines that appear at rest.
We refer to that as static lines.
Now in addition, there are some other lines that you are describing when you smile and
the skin just kind of pushes upward and I refer to them as kind of like the accordion
effect.
So that when your face is animated, it’s like an accordion.
It squeezes those lines and you’re creating those rippling in the skin.
So when I discuss options with my patients, I think of short term solutions as well as
long term solutions.
In the modern world where there are so many options and there are so many people offering
the latest greatest devices, I see too often people who are bouncing from one doctor to
another, from one medispa to another to try to catch up with what’s going on with their
changes.
So let’s first start with understanding the skin changes.
Is this related to genetics or heredity?
Is this related to environment such as sunlight and smoking?
Is it related to just stress or hydration?
Very often, there are factors in the history that we can counsel our patients on to help
improve the skin.
The skin around the eyelids is like a half a millimeter in thickness.
It’s very thin.
It’s practically transparent.
So trying to build collagen around this area, trying to improve this appearance has to be
done in a very artful way.
So in terms of dynamic lines, for dynamic lines, the gold standard is to use some kind
of neurotoxin.
This includes Botox®, Dypsort, xeomin.
Essentially, injectables that reduce muscle activity.
Now, that’s fine for the crow’s feet lines in the area.
But it is less optimal in the under eye area.
And that’s because the lines under the eyes are also related to the vertical lift of the
cheek.
So in our practice what we try to do with these lines which obviously really can’t
be filled.
Many have tried and most have failed because fillers such as in the hyaluronic acid family
just are too thick and makes this area look swollen.
When we treat this global appearance, we look at the static lines from a different lens.
And the static lines are basically a function of collagen loss.
So how do we address collagen loss?
We try to stimulate new collagen.
Now the traditional methods have always been about different types of thermal energy devices
and I’m a big user of the fractional CO2 laser as well as the occasional use of Pellevé
or radiofrequency.
So it’s not like I’m against thermal devices.
What I am against is the overuse of thermal devices.
A lot of people have come to me after they have gone to clinic A, clinic B, clinic C
and have been heated up, heated up to the point where the skin has actually become thinner
and more crepey and we’re trying to figure out how to help them.
Now to help them, we have been very successful in using something called platelet-rich plasma
which is your own blood’s plasma which has the healing and growth factors needed for
wound healing and through strategic placement over time, we’re able to build up the collagen
in the skin.
Now I describe this process similar to muscle building like going to the gym.
You work out and then you wait for the benefit of the muscle growth.
The same thing applies to skin, you treat and then you step back and then you allow
it to respond.
And we always have to customize based on the individual patient’s response.
You know some people respond better than others.
Now we often combine this because there is often an overlap.
If the person has wrinkles under the eyes and crepey skin, then very often they have
puffy bags or they have under hollows.
So for under eye hollows, we’ve also been very successful with using hyaluronic acid
fillers.
And in combination with hyaluronic acid fillers and platelet-rich plasma has actually been
very effective and is something that our patients have appreciated and seen improvement.
To address the issue or the discussion about the cheek volume, I think you’re in the
right track but not that it will fill the under eye area but what I always feel when
I look at the face because I’m a facial cosmetic surgeon, I do facelifts, I do cheek
implants, I look at the eyes as they relate to the cheek.
So I will very often add volume in the malar, submalar area, the cheek area, the apples
of the cheeks so that it’s not to exaggerate but rather to restore volume and the continuity
of that area with the under eye area can be very nice when you combine modalities.
If you think for a moment that there are people who are in their 20s, let’s say they are
surfers and they are out in the sun all the time and they’re photoaging the skin, they
are in their 20s, they are young, and yet when they have a lot of wrinkles under their
eyes, they look good.
And the reason is because they have volume.
And the volume is a key but the volume is also done in a way that is beneficial can
also be a negative.
So there’s an art to doing all this.
I think the key decision for you is to find the right doctor whom you feel comfortable
with, who will be your guide in this very tricky landscape.
So that you can have a strategy and you can build on top of the other.
In 20 years of practice, there have been patients who have been with me and we’ve grown together
and we’ve learn essentially how to customize for each individual patient.
It’s very important, otherwise, people who jump around from place to place looking for
the latest deal invariable waste a lot of money and don’t get good results and are
constantly just getting frustrated.
So I think that once you find the right doctor, these things will make sense.
There is a logic and if there isn’t good follow up, I don’t see the reason of just
trying to work on finding these names and solutions because you’re not going to, the
names like Botox®, Juvderm etc., these are tools for a skilled doctor and not solutions
unto themselves and this is why this is not a commodity.
It’s the real skill and the style.
That’s why there are many doctors who do it in different ways.
And we can all use different fillers and get comparable results depending on the shared
concept of the patient and the doctor have about what the desired outcome will be.
So I hope that was helpful, I wish you the best of luck and thank you for your question!