My injector says she does't think I need under eye filler. Can someone explain why that would be the case? (Photo)

Question

My injector says she doesn't think I need under eye filler because of my bone structure saying there would be no place to put it. Can someone explain why that would be the case? She says I have a high mandible I believe and it's already supported

Raffy Karamanoukian, MD, FACS · Answer

I would use a tightening RF device followed by conservative dermal fillers for your lower eyelids. This would help improve the contour.

Dr. Karamanoukian
Realself100 Surgeon

Nima Shemirani, MD · Answer

Hi @Original583209. I agree with your injector. Based on your photo--you have minimal volume loss under the eye. Best of luck, Dr. Nima!

Jason Emer, MD · Answer

For unique cases where a variety of modalities could be used to treat the condition, I would suggest an in person or virtual consultation to develop a custom and effective treatment plan.  It is difficult to precisely define the best option without collecting the same information. I suggest reaching out to an expert for a consultation with surgical and non-surgical methods to get a comprehensive option. Best, Dr. Emer.

Eric M. Joseph, MD · Answer

Digital photos are rarely a substitute for an examination. That said, you appear to have under eye grooves that may be amenable to filling, depending on your condition. In our practice, we prefer to use microdroplet Silikon-1000 for permanent results. Hope this helps! Doctor Joseph

Michael A. Persky, MD · Answer

Hi OG in MDR,
I would agree with your injector as you have minimally holowing under your right eye.  Hyaluronic acid filler injections are not without problems under the eyes, and in your case would not be worth the risk of swelling, migration, and/or fluid retention (malar edema.)  There may be a solution to your concerns.  I have treated patients like you with foundational Sculptra (deep injection below muscle and over bone) which helps to restore the early loss of facial bony volume.  Feel free to contact me to schedule an in person or virtual consultation to discuss your aesthetic concerns.  Good luck and be well.
Michael Persky, MD
Encino, CA

Robinson Facial Plastic Surgery - Alpharetta · Answer

Thank you for your question. Please remember that the practice of medicine is just that...a practice. Different providers have differing opinions and that is certainly the case in the aesthetic world. There are a few different reasons as to why your injector may have told you this. Here are some of those...
1. She may be right, and you may actually not need it. Even with ideal bone structure, you may need it in the future, but perhaps just not at the present time. 
2. Another possibility is that your provider may not feel comfortable performing this particular procedure, and she therefore does not recommend it, or does not want to lose your business.
3. Lastly, you may in fact need it, however, your provider does not feel that you do. This is where differing opinions are at play.
I always tell patients to appreciate when a provider tells you that you do not need a procedure. In this field in particular, practitioners typically work on commission, therefore, the more we do, the more we make. It does not benefit us in any way to tell patients not to do something. If you feel strongly about it, or have doubts about what she is telling you, get a second and third opinion from other experienced providers in your area. 
I can only give you a limited opinion based on the photo presented. From this particular photo, it appears that the left eye could possibly use a small amount of filler, but the right side looks very smooth. Lighting and angles play a HUGE role in how the under eye area looks in photos, so a face-to-face consultation is a must. Good luck!

David M. Kowalczyk, MD, MBA, FACS · Answer

Hi there! Thanks for your question. Under eye filler can be very tricky to get right if the starting point is already good as in your case. A soft product is often used that allows for improvement in contours. The under eye skin is very thin and can show the product as a bluish hue in some people or even lumps. We avoid placing filler within the lower eyelid due to the risks associated with doing so (proximity to the eyes / vision). It could be that your injector feels that the risk of it appear unnatural outweigh any benefit in your case. Hope this helps!

Viktoryia Kazlouskaya, MD · Answer

Fillers are used for undereye hollows, and not everyone is a good candidate. You look stunning in the pictures, there are no hollows/eyebags seen (at least in the pictures provided). Your injector is completely correct and saves you money and possible unnecessary complications. Best, Dr. K

Camille Cash, MD · Answer

It appears you have minimal volume loss under the eye.  If you do proceed with filler you will want to do so conservatively to keep a natural contour.  I've included a video on under eye filler that I hope you find helpful.

Reuel Aspacio, MD, FAAD - Account Suspended · Answer

Hi there, 
I agree under eye filler is not needed at this point.  You look great and your under looks great as well.
It is hard to evaluate without seeing your whole face but what I see is not a candidate for filler.

Best of luck!

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