Herniated Fat Pads Under Eyes. Would Belotero Be Effective? (photo)

Belotero is a new FDA-approved filler.  It is a hyaluronic acid (as are Restylane and Juvederm).  The approved indication for Belotero is for injection into the mid-to-deep dermis for correction of moderate-to-severe facial wrinkles and folds.  It normally can be used to improve the under eye area if there is a depression there.  

Typically reducing the appearance of herniated fat pads requires a lower blepharoplasty. It's not typically recommended to add filler to the area because it can make the area look puffier.

With regards to "herniated fat pads", one would need a lower blepharoplasty with fat pad transposition to help correct the tear trough deformity.  Dermal fillers, such as Restylane and Belotero, may help correct these tear trough deformities as a temporary solution.  I would recommend a bigger molecule such as Restylane for tear trough deformity correction.  Any excess skin and lower lid laxity will not be corrected by injection with a dermal filler.  Make sure that you're evaluated by a plastic surgeon before your procedure.

Boletero, Juevederm, and restylane (HA fillers) do not replace a blepharoplasty which can re-position or lessen the bulging fat. Instead it makes a smooth transition between the lower lid fat pad and cheek pad. In mild cases it can improve your appearance allowing you to delay the blepharoplasty procedure, or it can be used in conjunction with the lower lid lift in a synergistic fashion.

Belotero is a newer hyaluronic acid; however, it's one of my favorites as it is currently the thinnest filler on the market (Restylane Silk, which will make its debut in 2015, maybe even thinner). It works great in thin areas such as around the eyes to camouflage fat pads and in lip lines. Around the eyes, we're getting more than a year in many patients. Around the lips, unfortunately, similar to the other hyaluronic acids, we are getting maybe 4 months.Around the eyes, you really need an experienced injector.  It will not camouflage the bags completely however it can make a nice improvement in the area.  Belotero is not FDA approved around the eyes (but neither is any other filler and Belotero is still used in this area).

Belotero is a great choice for under eye treatment of a nasally located depression or shadow.  This is the area below the fat pad.  By elevating the depression, you make the fat pad less noticible.  This is FDA approved.  An advantage of Belotero is that you don't need to significantly undercorrect like some of the other fillers.  This is because it causes less of an osmotic gradient and draws less fluid to the region.  Good luck.  You look like a good candidate. 

One of the more difficult treatments with facial filler is under the eyes and cheek additions.  Belotero has several properties which make is a good choice for this, although other HA products can be used her quite successfully as well.

 

Seek an experienced injector for this area.  Less is more as under the eyes as well.  80% treatment (slight undercorrection) under the eyes is better than 105% (i.e. slight overcorrection) as the margin for error here is quite slim.

Yes Boletero can easily and safely be injected in the under eye area even if you have fat pads. We do not inject the fat pads, as the only solution for this a surgical option but we can reduce the  deep furrows under the fat pad to hide the fat pad protrusion. This will take away some of the "tired look". It must however be injected by a skilled injector because overcorrection in this particular situation will look awful!

Fillers such as Belotero (and now, Volbella) can fill in tear trough deformities under the eyes.  They are both FDA approved agents for injection.  Fat pad descent, however, is best treated with a blepharoplasty that actually removes these bags.  Injectable like Belotero may lessen their appearance, however, by smoothing the transition.

Nothing short of blepharoplasty can fully correct a weakened or defective orbital septum with herniation of fat.  But I have seen tremendous improvement in this problem with Beletero.  Beletero dies nit pull ir push the fat back, but it can smooth the furrows and hollow areas such that the fat is less apparent.  You should undergo a careful pretreatment evaluation, including a history and examination, before having Beletero. and physicians will be cautious about injecting anyone with a history of puffiness under the eyes in the morning that improves during the day. Your dictir will also be cautious about injecting someone who has had surgery to the lower eyelids, as these patients can have compromised lymphatic drainage from their lower eyelids, making it difficult to for the periorbital muscle and lymphatics to eliminate the fluid that is attracted to some types of fillers. It might help also to limit the amount of filler injected in this area in one session.            You can try the Beletero first to see if you are happy with the degree of correction, especially since it is very difficult to inject fillers under the eyes of someone who has already had lower eyelid surgery without getting some side effects, such as persistent edema.