The Tricky Area of the Lower Lid Hollow
Posted: 6:00 a.m. Sunday, Sept. 11, 2016
By Anita Mandal, M.D.
Question: A doctor injected the dark hollows under my eyes with Restylane. My eyelid hollows were less deep, but looked lumpy and uneven. After a year, the filler finally went away. How can I be sure that this won’t happen again?
Answer: The under eye hollows are a tricky area and should only be treated by an experienced injector who regularly fills this area. Anyone can take a 2 week course to learn injection technique. However, understanding lower eyelid anatomy and the special approaches that give a natural result in this area require much higher skill than that of the generic injector.
Firstly, lower eyelid skin is typically quite thin. Fillers placed superficially can easily give lumps and asymmetry. One filler of choice is Restylane which, however, must be injected deep onto bone in this area. In patients prone to lower eyelid puffiness, hyaluronic acid (HA) fillers like Restylane or Juvederm are not advised. HA fillers work by attracting your body’s water so injecting a water-retention prone area can make you look worse. My other filler of choice for the lower lid hollow is Bellafill. Not only does Bellafill last 5 years, but it stimulates your body’s own collagen so it is less prone to puffiness in the lower lid area. Bellafill, in my experience with using 2000 syringes in over 4 years, is ideally suited for natural filling of the lower lid hollow.
Because Bellafill is a 5 year filler, it’s important to seek a Belladiamond injector who has extensive experience with Bellafill to avoid being stuck with a poor result for 5 years.
Many injectors get into trouble with the lower lid hollow because they fail to recognize the anatomic relationship between the cheek bone and the lower lid hollow. If the upper cheek is hollow or underprojected, it should be treated with filler at the same time as the lower lid hollow to avoid the appearance of filler bulging from the lower lid into the cheek and giving an unnatural, distorted look.
A skilled surgeon also looks at the entire width of the eyelid hollow to determine the choice of filler. While Restylane works well in the hollow under the inner half of the eye, injecting it along outer eyelid hollows can give lumps. Bellafill, however, is quite effective in treating the entire lower lid hollow including the lateral portion.
Choosing a skilled injector, who is a board certified Facial Plastic Surgeon and understands the intricate anatomy of the lower eyelid hollow as well as the pros and cons of various injectable fillers, is the first step towards natural and satisfying rejuvenation of the tricky area of the lower lid hollow.
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