I am 24 and I don't have a single wrinkle but I do have some serious hollowing going on under my eyes and when I smile I notice that it looks like the skin in this area folds up like an accordion. I read that Restylane is the filler of choice for eye hollows but I'm worried that if injected it could look good when my face is at rest but weird when I smile. Could it make the dynamic wrinkles under my eyes look worse? I know it can be dissolved, but could Hyaluronidase create even more hollowness?
Restylane for Eye Hollows and Dynamic Under-eye Wrinkles? (photo)
Doctor Answers (5)
Lower eyelid hollow and wrinkles
The hollowness under the eye typically starts at the inner corner of the eye and extends toward the cheek in an oblique direction as you show on your photo. This is referred to as a tear-trough. In some individuals the hollowness continues along the eye-socket toward the outer aspect of the eye. This causes a dark circle. If you will notice, the smiling picture does not show circles because the cheeks came up toward the eyes and filled the hollow. That's why using a filler in this area improves the appearance.
As far as fillers go, hyaluronic acid (Restylane, Juvederm) works the best in this area. It has to be injected very carefully since the tissue in this area is very thin and the material may show through as blue bumps. The best solution is fat grafting. But it's an operation and more costly although the result is longer lasting.
Normally there is a roll of muscle under the lash line when one smiles. It seems that that is what you have. In addition there are some fine lines. They don't appear to be obvious. But if you desire an improvement, they could be treated with a chemical peel or laser treatment. The fine lines would improve. The roll of tissue would not change. Actually the rolls make one appear more youthful.
Hope that helps.
Tear trough treatment
Based on your photos it appears that you are a good candidate for treatment to your tear troughs with either Restylane or Juvederm. Properly injected, either dermal filler won't look "weird" when you smile. Adding Botox or Dysport to soften those fine lines and creases around your eyes would complement the area nicely. You aren't too young to start with preventative treatments. Always be sure to consult with an experienced and well-trained injector for optimum results and follow up to ensure you get the correction you are looking for.
Restylane for eye hollows and dynamic under eye wrinkles?
Fillers are good to fill in any areas with volume loss. It looks like you have some hollowing on the under eye area. Also, best to assess the area in person to give you the best treatment plan. It shouldn't make your under eye wrinkles worse when you are smiling because fillers do not work on dynamic wrinkles. It should help.
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Use of tear trough filler like Restylane
I use a tremendous amount of restylane in the tear trough area with excellent results. Although I have never had to with any of my own patients, there is also an antidote "hyaluronidase" if you didn't like the restylane or juvederm in the tear trough which can dissolve some or all of it. Restylane comes in a full and half-syringe, and because you are young and this is your first time, you may just want to try the half-syringe so as not to overdo it and allay your concerns regarding making the face look weird when you smile. Make sure you go to an experienced injector such as a dermatologist to ensure optimal beauty and safety.
Restylane for Eye Hollows and Dynamic Under-eye Wrinkles?
Restylane or Juvederm would fill your under eye area and would be a nice improvement for you. It should not affect any dynamic lines around the eyes. However, filler can be combined with Botox treatments around the eyes for a very nice result. I hope this information is helpful.
Stephen Weber MD, FACS