What is the best injectable dermal filler (apart from fat) for under-eye hollowness? What about upper-eye hollowness? Is this safe?
Best Injectable Filler for Undereye Hollows?
Doctor Answers 18
Hi Hot Nani in Hotlanta,
I went to medical school in Atlanta, so I will try to answer your question with Emory pride. I have used both Restylane and Juviderm for facial filling; they are both very good hyaluronic acid filler products.
Under the eyelid in the tear trough depression area, I have again used both fillers. I have found that Restylane is most dependable in that what I put in won't go "crazy" with puffiness and swelling. I have not had any problems at all with Restylane in this area. On the other hand (or tear trough hollow) though I have treated a few patients with Juviderm in this area, after my second patient had swelling and edema (with identical technique and under correcting) I have stopped using Juviderm there. Most of the patients looked great, but I found Juviderm to be unpredictable in this sensitive area. Many other facial plastic surgeons have shared similar experiences with me. I am not a speaker or representative for either company. Make sure that you choose your experienced physician carefully for injections in this area.
Once successfully in place, Restylane in this area has impressed me with it's longevity of up to and many times longer that one year.
William Silver, MD in Atlanta is a very well respected facial plastic surgeon.
Fat Grafting to correct hollows of Upper or Lower Eyelids
Fat Grafting requires specialized training and specialized surgical instruments, as well as patience and attention to detail on the part of the surgeon. When performed properly, permanent improvements in facial plastic surgery are possible.
The technique I use, structural fat grafting, in which small amounts (less than 0.1 cc at a time) of fat are carefully microinjected with a blunt cannula - not a needle, in a series of discrete layers to gradually 'build' new soft tissue structure. As there is space between each microinjection, new blood vessels are able to grow into the grafted fat, allowing it to persist. If this process of blood vessel ingrowth (neovascularization) does not occur, then the injected tissue cannot truly be considered a 'graft' and is instead just another 'soft tissue filler' of limited duration.
It is important select a plastic surgeon with specialized training who performs fat grafting often.
I use Juvederm
I never use a dermal filler in the upper eye. Under the eye, I use Juvederm in the so-called 'tear troughs.' No dermal filler is FDA-approved for the tear troughs, but this is commonly done as an off-label usage. It is generally safe as long as it is done only in the inner half of the eye (medial to the mid-pupillary line). Very small amounts are used, less than a full vial of Juvederm, so the rest can be used elsewhere. It is a subtle result that makes one look much less tired, but not fake or 'like something was done' at all.
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Best dermal filler for under eye hollows
This is a tough question and to some degree it is a matter of opinion and personal preference. I want to clarify that although a dermal filler is being used, the vast majority of physicians do not inject this into the dermal or subdermal layers but instead prefer to inject deep.
Probably more important than the filler is the technique of injection. Physician instructors describe a variety of approaches to this anatomy. Materials injected include: Radiesse, Perlane, Restylane, Juvederm, Hylaform, Prevelle, etc.
I personally prefer Juvederm, and I tend to inject it deep to avoid visibility or palpability. I have also used Radiesse with good results in patients requiring greater volume correction.
Restylane is the best for the lower lids
For improvement of the tear troughs of the lower lids, the best injectable filler is Restylane. It works extremely well and lasts approximately one year in this area in my experience. It is best in the younger patient with early aging of the lids and thicker skin and not so good in the older patient with thin fragile skin.
There are certain fillers that are safe for hollowing under the eyes. Typically, the hyaluronic acid products such as Restylane or Juvederm can fill in the hollowing of the lower eyelids very nicely.
The eyelid skin is some of the thinnest skin in the body so you want to make sure the injector is comfortable with the eyelids so as not to cause too much lumpiness or stranding. I usually recommend to my patients that they try a non-permanent filler always before a permanent filler to make sure they are pleased with their result and have no adverse reaction.
These hyaluronic acid products are very safe products and when used judiciously can eliminate the hollowed appearance the lower lids can take on with aging as we lose fat.
Best injectable filler for eye hollows
Belotero or Restylane is the Best for Tear Trough Injections
Fillers for the Undereye Hollows
That being said, I often suggest that my patients who wish to treat their under eye area use Restylane. Restylane is an instant volumizer that requires virtually no downtime. Not only does it have a short downtime, but Restylane also holds a number of advantages over more popular dermal fillers. For example, Restylane generally lasts longer than collagen injections, owing to its relying on the body’s own moisture to fill out the skin.
Better yet, Restylane is a non-animal (and hence cruelty-free and vegan-friendly) biodegradable gel based on hyaluronic acid, a polysaccharide found within the skin that provides volume and pliability. What makes hyaluronic so notable is that it can hold up to 1,000 times its weight in water, thus making it ideal for those looking for a no-fuss dermal filler. Even while the filler itself is being naturally degraded, the filler’s hyaluronic acid still continues to attract water, which in turn means that your skin won’t go from perfectly plump to noticeably deflated as the filler wears off. Restylane is suitable to use around the mouth, nose, eyebrows, and eyes.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.