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Key Points For Treating The Aging Lower Lid Hollow

Posted: 6:00 a.m. Sunday, Aug. 20, 2017

By Anita Mandal, M.D.
Question: I went to a doctor who was not certified by any plastic surgery board. I thought it would not matter since I was just getting fillers and not plastic surgery. The doctor put filler in my sunken lower eyelid area to make my dark circles look better, but now I look like I have a huge overfilled area extending from my eyelids to my cheek with no facial definition. What went so wrong?

Answer: Your story is a classic one. A patient coming to see me for the first time, after having an unsatisfactory filler treatment by a less skilled “filler” doctor, is not an uncommon occurrence. While it’s not hard to go off to a one week course to learn filler injection techniques, understanding the fine differences in aging facial anatomy is an entirely difference ballgame.

In fact, one of the most common aesthetic errors in facial volumization that I see is a bulging lower eyelid with protrusion of filler down into the upper cheek. When assessing the lower lid hollow, it’s not a simple matter of just filling the area if there is hollowing. It is crucial to look at the anatomy of the surrounding tissues. First, one must assess for the presence of bulging fat in the lower eyelid and determine if there is true hollowing under the eyes or if the hollows are only an illusion and the result of protruding lower lid fat. This approach will help your surgeon decide if the treatment should be surgery for lower lid fat removal, injectable fillers or combination therapy.

Secondly, one must look at the anatomic relationship between the lower eyelid and the upper cheek. Specifically, the anterior projection of the upper cheek compared to that of the lower orbit rim or eye socket is key. While this may sound a bit too technical to mention here, my point is that the relationship between the lower eyelid rim and your cheekbone significantly impacts how to inject filler for a youthful, yet natural rejuvenation. A “filler” doctor with limited knowledge of the intricate anatomy of this lower lid – upper cheek region will fail to recognize unique anatomical issues and the proper treatment approach.

As an example, when a hollow lower lid has a rim that projects more than the upper cheek, volumization of the upper cheek is just as important as that of the lower lid hollow. While some doctors may be reluctant to inform the patient of the higher cost of treating both of these areas rather than one area, a well informed approach can prevent the kind of overfilled, unnatural look you have experienced.

Careful consultation with a Board Certified Facial Plastic Surgeon who thoroughly understands the complex facial anatomy of surgery and facial aging is the first step in helping you choose the most natural and suitable rejuvenation approach for you.

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