Thank you for your question. You state in your question that you're twenty-nine-years-old
and you want to look as young as you feel and that you had some Restylane 0.5cc placed
in your tear trough area and you're looking for an additional opinion about your situation.
Well I can certainly assist you with this question I'm a Board-certified cosmetic surgeon,
fellowship- trained Oculofacial plastic and Reconstructive surgeon, that means my first
area of training was an eye surgery followed by specialized training in plastic surgery
of the eyes and I've been in practice for over twenty years.
So it's interesting when someone is twenty nine, feels and describes in a question that
they want to look younger, so I can say that you probably on the right track in terms of
the perception of how to improve the appearance under your eyes, but what I think you should
also look at is really why would you need any volume under your eyes as you described
you're describing the tear trough. When I see this photo what I see are puffy
bags under the eyes. Now puffy bags under the eyes are most likely the result of something
called lower eyelid fat prolapse.
Lower eyelid fat prolapse means the fat that's around your eyes is pushed forward and has
created this bulge. So in essence what you're describing maybe as a trough is really the
contrast between the elevation of the fat which is like a mountain and the rim of that
mountain which we can think of as a valley.
That being said, the area where it appears that you had to fill the place was basically
at the base, at the lowest part which often is referred to as the V deformity and it's
been probably successful in softening that transition.
But I still feel like when we look at this photo that your eyes, the dominant features
still puffiness. So I think that's something you should consider exploring is something
more definitive and I would probably recommend something like a Lower eyelid blepharoplasty.
Now that might sound like a lot for you considering that you feel like at twenty-nine that you
may be relatively young for this. But lower eyelid blepharoplasty is something I've performed
in patients as young as fourteen who have bags under their eyes.
The fillers can have a role in helping to soften the appearance of puffiness but it
has to be only on slight puffiness, if you think about it, how much more volume can you
put under your eyes to meet this hernia and that is what referred to as herniated fat.
In someone like yourself we will typically do what is called the Transconjunctival blepharoplasty
this is performed under local anesthesia with light sedation it's done from the inside of
the eyelid. The reason I'm suggesting this, is that we
see a lot of patients as a specialist as someone as an Oculofacial plastic surgeon specialist
in eyelids. We see patients who come from everywhere who have all kinds of volume of
fillers such as Restylane and Juvederm and they come to us to dissolve that filler because
the doctor who did it intended to try to help them by softening that transition and it creates
too much volume. so I think that you need to consider this as a strategy, many people
who are afraid of having surgery are afraid of the whole process but we simplify it for
our patients we do these procedures in our operating facilities in our office under local
anesthesia with light sedation and a hospital level facility certified by the joint Commission
and the paradox is that many people want to avoid the bruising and things that are often
seen after surgery. but I can tell you that we have patients who after a week have almost
no bruising and that as well the irony we've seen is that we've seen patients who come
in where the injectable done elsewhere and they look pretty bruised after their injectable.
Certain the use of blunt tip cannula is useful and I am no stranger to that I use blunt tip
cannula in a lot of things I do for injectable.
But nonetheless we have to think of the underlying cause so think about that, and learn more
about your options and meet with doctors who might appeal to help you make this decision.
So I hope that was helpful I wish you the best of luck. Thank you for your question