The eyes are one of the first areas that can show our age. Sagging skin and wrinkles can appear around the eyes, and dark under-eye circles can make us look more tired or older than we are. Using injectable facial fillers, neurotoxins such as Botox and Dysport, and laser resurfacing, Dr. Levin can help mitigate some of these common signs of aging. 

Under-Eye Fillers

Fillers can be used in the tear trough, eyelid, and cheek areas to reduce the appearance of dark circles and shadows. The tear trough is the crease in the inner part of the eyelid. Some people are born with a more defined tear trough, while in others, the natural loss of facial volume from aging can make the area look more prominent. The relative lack of fat in that area, combined with thin skin and concavity, creates the appearance of dark circles. The herniated fat can further accentuate the shadowing in those with eye bags, like a peak casting a shadow to a valley beneath it.

This shadowing can be isolated to the tear trough area or the entire eyelid, with a ledge and a visible line at the outer edge. In the right candidate, the filler can be placed in the tear trough area or along the entire eyelid-to-cheek junction to create a smooth transition and improve or eliminate the shadowing. Typically, the fillers used to treat this area are made from hyaluronic acid, a compound found naturally within the body. Moreover, only a few subtypes of hyaluronic acid fillers have the properties that make them ideal for this area.

Under Eye Filler Candidates

The eyelid area is unique from the rest of the face. Not everyone is a candidate for filler, and not every type of filler is appropriate for use there. Proper patient selection is the most important determinant of successful results. During your consultation with Dr. Levin, she will assess whether you are a good candidate for non-surgical means to help with your concerns. Ideal candidates for undereye and tear trough fillers have excellent skin tone and none or minimal undereye bags.

With more prominent undereye bags, the candidacy for filler becomes less ideal, and surgery gives the best results. If filler was placed inappropriately, the wrong filler was used, and the results were unsatisfactory. As long as it is a hyaluronic acid filler, it can be dissolved. Once dissolved, Dr. Levin will re-assess and advise the proper treatment. More than one treatment may be necessary to achieve the best outcome, and the results last 9-12 months. The amount of filler needed depends on the degree of hollowness, skin thickness, and expectations.

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Upper Eyelid Filler

The upper eyelid can also be treated using injectables. Here, the filler is used to correct the hollowness of the upper eyelid and the area under the eyebrow. With age, our eye socket expands in a non-uniform manner. In some people, this is accompanied by atrophy of the upper eyelid fat. This expansion and deflation results in the loss of youthful upper eyelid fullness. The atrophy can be more pronounced in the innermost aspect of the upper eyelid, causing what is called an ‘A-frame deformity.’ The hollowness can also be uneven, creating an asymmetry between the two sides.

Sometimes, patients interpret this as having a droopy eyelid on one side, as the hollowness exposes more of the eyelid, simulating what a lid looks like when it's droopy. Treatment with filler in the upper eyelid is reserved for two types of patients. Young patients with excellent eyelid skin but the hollowness of one or both upper eyelids or older patients who underwent a blepharoplasty still need volume replacement to enhance their results further.

Patients who had an overly aggressive blepharoplasty where the surgeon removed too much fat may benefit from this procedure. Treatment is done over one or a series of treatments, depending on the degree of volume loss. A small amount of filler is injected with each treatment, and the appearance is re-assessed in 2-3 weeks. One unique aspect of the upper eyelids is the longevity of the filler there, which unlike most other areas of the face, often lasts a few years.

With excellent skin tone, Neuromodulators are a type of injectable treatment such as Botox designed to help relax the muscles in a specific area. By stopping facial muscles from contracting, the skin in the area can be smoothed and wrinkles erased or reduced. The treatment works by injecting some of the product around the eyebrow or eyelid area. This will help lift the area and create more of an arch of your brows.

Other Non-Surgical Treatments of the Eye Area

Dermal fillers address hollowness but not wrinkles or skin texture. In fact, when injectors try to correct eyelid wrinkles with filler, they often run into trouble with results that don’t look good. That is because eyelid filler must be placed deep, under the skin and muscle, not just under the skin.

To improve fine lines and wrinkles, it's best to resort to neuromodulators, such as Botox and Dysport, as well as chemical peels, lasers, or microneedling.

Patients bothered by dark circles and crepey eyelid skin find that combination treatments give the best results. When considering both filler and skin-tightening treatment, Dr. Levin recommends skin-tightening to be done first, followed by filler because tougher skin quality will give better filler results. Unfortunately, one problem neither laser nor filler will help with is hyperpigmentation of the skin itself.  If there is pigment in the skin, that is best addressed with topical bleaching treatments or creams.

Recovery After Your Non-Surgical Treatment

The recovery of course depends on the specific treatment. After treatment with filler, you will be able to go home and resume most normal activities. Exercise or other strenuous activities should be avoided for the first day, as well as touching or rubbing the treated area. It is very common to have mild-to-moderate swelling of the treated area, and for it to feel slightly firm or lumpy. That usually resolves in 5-7 days. Bruising is also possible, so it's best to plan this ahead of any important social events.  After laser or chemical peel treatment-specific instructions are given for how to care for the skin. The extent of the aftercare and the downtime depend on the laser used, more involved with the CO2 laser and less with non-ablative treatments.

Non-Surgical Eye Rejuvenation Candidates

During your consultation with Dr. Levin, she can assess if you are a good candidate for tear trough fillers or eyelid rejuvenation. Ideal candidates would have thicker skin beneath the eyes and deeper creases for tear trough fillers.

For upper eyelid treatments, candidates should have some moderate sagging above the eye. Because these treatments are not surgical, it is essential to have realistic expectations of what they will achieve. It should also be noted that the treatments are temporary.

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The Touch of an Expert 

Dr. Flora Levin is a board-certified oculofacial plastic surgeon with extensive experience in eye rejuvenation. She has performed thousands of surgical and non-surgical eyelid procedures and teaches and trains other providers how to perform them best. If you are interested in non-surgical eyelid rejuvenation, contact our office today to schedule your consultation. We look forward to meeting you!

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