Under eye circles and puffiness can work together to create a tired
appearance, making a young face look old and an older
face appear even older. Many women obsess about under eye problems, creating a
market for an endless and confusing array of products, including creams, gels,
concealers, brighteners and rollerballs.
Lower lid blepharoplasty, which removes excess under eye skin
and fat is a tried, true and well respected surgical option, but recently a
nonsurgical fix has emerged. Hyaluronic acid, marketed as Restylane, Juvéderm
and other soft tissue fillers, can be injected into the tear trough
(crescent-shaped under eye area) to rejuvenate the appearance of the under eye
area.
What causes dark
circles?
Many factors contribute to dark circles, but the common
denominator is heredity and genetics.
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Most frequently,
dark circles are created by volume loss in the under eye area that exposes the
orbital bone, creating a hollow trough that shows up as a dark circle. The
delicate eye area, with its extremely thin skin, is one of the first spots to
reveal signs of aging.
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Dilated blood
vessels that sit close to thin under-eye skin are another cause of dark
circles.
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Airborne allergens,
which cause blood to pool in the vessels under the skin, can worsen the
appearance of dark circles. (Treatment for this may be as simple as an
antihistamine pill.)
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Aging, which causes
skin to thin, can darken the eye area, as can certain medications such as birth
control pills, which can dilate blood vessels.
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Sun exposure makes
dark circles worse.
Advantages of
injecting soft tissue fillers in the under eye area
The overall aim for soft tissue filler injections in the under
eye area is to improve rhytids (wrinkles) and thinning under eye skin (which
leads to sagging), and to decrease bulging under eye fat as well as the tear
trough depression. Here is some more information:
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In the early 90s,
plastic surgeons began to use fat, which was removed during blepharoplasty, to
fill in the tear trough depression. This usually led to swelling for several
weeks and occasional problems with lumpiness in the lower eyelids. With
Restylane or Juvederm, if you are unhappy with results, you don’t have to wait.
Results can be altered with Hyaluronidase; this product dissolves and degrades
the hyaluronic acid product to reverse the results of the injections.
·
Soft tissue fillers
may not only add volume to the depression of the tear trough, but can also be
used to thicken the anterior lamella (lower eyelid skin and orbicularis muscle)
of the lower eyelid, which can in turn hide a lot of the aging changes
underneath.
Success of Under
Eye Injections Depends on the Skills of the Injector
Injecting dermal fillers under the eye is a very
"technique-dependent" procedure.
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If you’re young,
with significant tear-trough deformities, your problems are not due to
thinning. A 22-years-old has a nice thick dermis, but may have a volume
problem, so your practitioner may use a fairly deep injection technique.
·
If you have severe
tear-trough deformities and a lot of thinning of the soft tissues, your
physician may use a "sandwich technique," putting a large, thin,
superficial sheet above the orbicularis oculi muscle (closes the eye) and then
a similar sheet immediately below the orbicularis oculi, making a sandwich out
of that muscle between sheets of the filler. This allows for more product in
the area and also allows for more thickening of the soft tissues, which helps
to hide a lot of the underlying aging problems across the entire lower orbit.
Bottom line: Find a physician who is board-certified in an
appropriate specialty and then make sure that he or she has a long history of
performing this procedure.
Who is the ideal
candidate for under eye injections?
·
If you have a
significant excess of bulging lower eyelid fat, you are not a good candidate.
You would probably do better with a lower-lid blepharoplasty.
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Any age is
appropriate.
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Men and women are
appropriate. Women usually have a little more problem with thinning of the
dermis; however, as men age, they have this problem too.
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Fillers are also
appropriate if you have had a previous lower eyelid surgery and now appear too
hollow. Fillers can restore volume nicely.
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For an older
patient with almost translucent skin, fillers will not result in a perfectly
smooth eyelid. The goal may be to decrease the apparent depth of the tear
trough.
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If your biggest problem is dark circles and
not a puffy fat pad, be aware that this treatment is not a skin-lightening
procedure. It will help with the shadowing, which contributes to dark under eye
circles.
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If you are looking
for something permanent, you may be a good candidate for blepharoplasty.
How Will You Look
Following this Procedure?
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You will probably
be asked to come back to the office around day 5 to see how the product settles after your
treatment.
·
Your lower eyelids
be slightly swollen for about three days after treatment; this is not a
zero-downtime procedure.
What is the main
safety consideration?
·
Side effects
can include bruising, swelling that can last for a week or two and on rare occasions an allergic
reaction.
Although the FDA has not approved the use of Restylane and other
soft tissue fillers for tear trough injection, many practitioners inject soft
tissue fillers in the under eye area with success. Choose a skilled, plastic surgeon, or
ophthalmic surgeon who is experienced in under eye injections. Results last
about eight months.
