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Technical Finesse In Treating Deep “Eyelid Circles”

Posted: 1:53 p.m. Friday, Jan. 17, 2014

By Anita Mandal, M.D.
Question: I have had the hollows under my eyes treated with fillers by several different plastic surgeons over the years. Each time, I either end up looking uneven or too puffy. Are there certain techniques that can give me a natural look?

Answer: Filler injections for the hollows under the eyes require greater technical skill than injection of many other areas of the face. Factors to be considered prior to filler treatment of the eyelid hollow include:

  • type of filler used
  • depth of injection
  • location of the bony eye socket rim
  • extent of hollow and how far outward it extends
  • presence of eyelid fat and muscle
  • presence of malar (cheek) hollows
  • head position during injection
  • eyeball position during injection

While many surgeons are aware of some of the variables listed, head and eyeball position are often overlooked. In my practice, the head is typically kept in neutral position during injection. An extended head position can falsely make the hollows appear less deep and negatively impact the quality of the final result.

Additionally, when the eyes are looking upward, the hollows become more noticeable whereas a downward gaze can make the hollows disappear. For this reason, I direct my patients to not only keep their eyes open but also to look straight ahead or upward during treatment.

Careful attention to head and eyeball position can improve the accuracy of lower eyelid hollow filling and the overall quality of the result. A thorough evaluation by your Facial Plastic Surgeon to identify the cause of and approach to deep lower eyelid hollows is the first step.


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