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Q:

I’m 32 years old and lately my eyes seem to have gotten more hollow looking. I want to get them filled but am scared cause I’ve heard some horror stories. When I do got them filled what filler should I use? Should I do my cheeks as well? And if anyone has any recommendations on injectors in the Atlanta area I would appreciate it. I’m not sure if I’m too young for this and don’t wanna end up ruining my face.

A:

Hello and thanks for posting.

The standard approach for treatment of under eye volume loss is to use an HA facial filler like Restylane. The under eye area is an advanced injection region and should only be performed by an injector with significant experience and advanced skills. Many people do not realize that there is an antidote or reversal agent for HA fillers called Hylenex. This enzyme can be injected into areas of excessive HA filler and immediately reverse the filler. This sometimes needs to be done when injecting the under eye region and many injectors will under treat this “tear trough” region and do the correction in a series of treatments to avoid overfilling.

Another approach that does not get much attention because it is so new are using PDO threads to restore under eye volume. These threads are dissolved gradually over time and collagen is produced in the process.

Please see the video below that demonstrates this technique.

Video on Under Eye/Tear Trough

Dr. Pierone demonstrates a new technique using PDO Threads in the Tear Trough. PDO Threads are cannulas and/or needles preloaded with an absorbable PDO suture that tightens the skin.

Q:

I’ve heard a lot of doctors don’t want to do Bellafill under eyes. I think it’s because they want you to keep coming back for more temporary fillers. Anyone had good experience with Bellafill under eyes?

A:

I don’t think many practitioners avoid Bellafill in the under eye region because they want to maximize profits, rather they are concerned about potential complications if it does not go well. Let me clearly state that the under eye region should only be injected by advanced injectors and this includes injections with reversible HA fillers. The skin is very thin in this region and any contour irregularities will be immediately apparent.

I have seen excellent results with Bellafill in the under eye region, but in a small percentage of patients have also seen complications that are a challenge to correct. I think the key to using Bellafill in this location is to ensure that the product is placed under the orbicularis oculi muscle directly on periosteum and in small amounts. For many patients, this approach will not fully correct the volume loss and then an HA filler (Restylane for example) or PDO threads can be layered into the areas of superficial volume loss.

Q:

What procedure will help get rid of this creepy skin under my eyes ? I got Botox for my crows feet 5 yrs ago and didn’t like how my eyes stayed too still when I smiled . Also felt weird sensations in the area . Sorry the pics are upside down . Can’t make them load upright for some reason . Thanks so much !

A:

PDO threads are one of my favorite treatments for under eye volume loss. These are not appropriate when there is a significant amount of volume loss, fillers work faster in this situation. But for someone like you who has minimal volume loss and creepy under eye skin the subtle volume restoration of PDO threads fits the need precisely.
This linked video demonstrates the technique.

I hope that this information helps and best of luck to you!

Q:

I’ve had dark circles all my life, my mom and sister have told me that since I was a toddler, they were always there. I don’t know if their getting worse, or since I’m older now, I recognize them more. I hate seeing them and I’m tired of always looking tired when I’ve had more than enough sleep. I took as much photos as I can, of all the angles. Now, my question is, will under eye fillers be the right option for me? If so, which one do you recommend?

A:

Under eye volume loss and dark circles make people look tired and older. As in your case, some people have a genetic predisposition to this problem.

The good news is that facial fillers and PDO threads represent an excellent non-surgical treatment for this condition. Injections into the under eye region should only be performed by expert injectors because it is an advanced treatment area. Intemperate placement of filler can worsen the problem

The Restylane family of products work well for under eye volume and my favorite approach is to use a 50/50 blend of Restylane Lyft/1% lidocaine. It also is best to restore volume in this location in a series of gradual steps for best results. If there is residual laxity of the skin after fillers, then placement of collagen stimulating PDO threads is a great way to complete the correction.

Above please find a link to a video of PDO threads for under eye volume loss.

I hope that this information helps and best of luck to you!

Q:

I am 47 years old. I get Botox but am frightened to try filler as I have seen some terribly unnatural looking results on my peers. Any other option besides blepharoplasty which I would be open to considering….

A:

Hello and thanks for posting.

You look great for 47, and your baby is adorable.

Facial fillers are the preferred means of correcting under eye hollows. There are many choices, but finding an expert injector is more important than the product. The under eye region should only be addressed by an advanced injector because the skin is very thin and this zone is unforgiving. Any contour irregularity from a poorly performed procedure would be the first thing that you and anyone else would notice.

Another option for under eye volume and collagen restoration is the use of PDO threads. I don’t know if they are available in Australia, but I assume they are since you are closer to China and Korea, the source of PDO threads for the US. As compared with facial fillers, PDO threads are more subtle, produce a more gradual result, and require multiple treatment sessions. But the results are very natural and quite durable as well.

I hope that this information helps and best of luck to you!

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