Thank you for your question. You submitted a photo, and state you want to know what the fine circle around your eye socket is called, and how to go about erasing it.I can share with you how I approach patients in my practice who share similar concerns, and explain the different issues that cause and create this type of appearance. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. Helping people with the under eye area has been a significant part of my practice. I have developed a lot of different strategies to help my patients based on an evolution of technology, as well as greater knowledge about this particular area. It is important to understand what is causing the line, and what the options are to improve this.One of the critically important things to understand is with facial aging comes a significant amount of volume loss. This means there is a decrease in the bone structure, particularly in this area of the eye socket called the orbit. The orbit and the cheekbone, the zygoma, have a very important relationship. Volume loss is loss of fat, muscle, soft tissue, fat, and the skin itself also gets thinner. Sometimes it’s referred to as a skeletonization as you start to see some of the underlying structures.When you see this line, it is a ligament that connects the skin to the eye socket. As a physician looking at this area, I think it’s less productive to chase lines. In many ways, the gold standard of wrinkle treatment has been to erase wrinkles, whether it’s with creams, lasers, or injectables, there’s always, “chasing the lines”.What I think is more relevant, and you can look at people who are considerably younger with similar issues, is the balance of facial harmony. What I mean by that is when you look at your eye, look at the eye and the cheek together, and there are certain things that you can notice. You might be able to appreciate that above that line is a little puffiness which means a little bit of fat normally around your eyes is pushing forward, called lower eyelid fat prolapse. Below the line, the cheek volume may be also diminished. There is a strategy I often recommend to my patients, depending on what they look like in three dimensions in front of me. When I do an analysis in my practice, I take pictures from multiple angles so patients get to see what they look from angles they don't usually see when they take a picture. When they take their own picture, they are usually smiling, and usually posing. When you’re taking medical photography, you’re taking photos of faces at rest, and with specific movement if those movements are relevant. Placement of fillers in this area to help improve the valley next to the elevation of the fat pockets in an area called the tear trough, to the orbital rim area can help. Fillers are usually in the hyaluronic acid family. An important caveat is placing fillers just in the edge may soften that line, but it will not make you look significantly better. We suggest to a lot of our patients to consider procedures such as Structural Volumizing. Structural Volumizing is a very specific technique using a thicker hyaluronic acid filler such as Juvederm Ultra Plus or Juvederm Voluma. By placing it at the bone level between the bone and muscle and restoring volume in the cheek, a very natural projection is created that very often contributes significantly to improvement in the eye area. We have not only zone in an area of concern, but look at the whole face in context, and look at facial harmony and balance. There are a lot of options beyond just fillers. There are ways to also improve skin quality, be it lasers, or emerging technologies in regenerative medicine such as platelet-rich plasma (PRP). It’s important you meet with qualified, experienced cosmetic surgeons who work a lot in this area, and understand what you are concerned about. I find that a lot of patients come in who are unsure on why they went to a doctor, got a filler in the place they wanted, and yet were dissatisfied. I would argue that it’s about harmony. People want to look better. We as human beings can identify certain lines or characteristics more globally, then you can get a lot more of satisfaction by understanding the relationships that help you look better, and not just addressing individual lines. I hope that was helpful, I wish you the best of luck, and thank you for your question.This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.
Hi nzeyewrinks,If your are referring to the "shadowed" area under your eye, it is called the tear trough area. Chronological aging causes fat loss and bone resorption so that the area appears dark and hollowed. Photodamage causes the skin around the area to thin out, lose elasticity and look crepey.Hyaluronic acid fillers such as Restylane Refyne and Juviderm Volbella are produced using new technology. Results are more natural looking and longer lasting. Results are immediate and the procedure is quick and relatively comfortable. There is no downtime.Although that is the definitive treatment, you can also ward off years by using protective sunscreen and using serum or creams for the eyes that contain Vitamin C, hyaluronic acid, caffeine and other substances that promote clarity, reduce puffiness and slows down the formation of lines.All the best, Justin Harper, M.D.
