Would my hollow periorbital rim benefit from filler? (Photos)

Question

Hi I feel like I have dents/hollows around my eyes and that the transition to my cheek area is harsh. Would I benefit from filler? If so what’s the best option so that I don’t end up retaining extra fluid in that area or getting lumps? I tend to old into extra fluid sometimes with filler in other areas and I also don’t want to end up with the Tyndall effect. Any help/suggestions would be greatly appreciated. Thank you

Nima Shemirani, MD · Answer

Hi @mememe12. Thank you for sharing your photos.  You would be a great candidate for tear trough 
fillers. Restylane and Belotero work great.  I recommend seeking treatments from expert injectors who have the skill and experience to precisely inject fillers into treatment areas and avoid risks and complications.

Best of luck,

Dr. Nima

Jason Emer, MD · Answer

A combination approach will give the most improvement. Fillers, lasers, and microneedling/PRP can improve under the eyes. My patients try to get non surgical treatments to avoid surgery. We use PRP and stem cells there often. I suggest consulting with an expert to develop a treatment plan best suited for your short and long term goals. Best, Dr. Emer

Dima Ali, MD · Answer

I think you would benefit from a little filler - 0.5mL at the most.  It needs to be injected deeply though to avoid the issues you mention.  I use a blunt tip cannula for this area to minimize the chance of bruising.

Lorrie Klein, MD · Answer

Fillers might help your under eye hollowness problem but you would need to be examined first since it is hard to tell by your photos.  Make sure to go to a specialist who also has a lot of experience treating under eye/ tear trough hollowness with fillers.  The more experienced he or she is, the less chance you have of having a problem.

Joseph A. Russo, MD · Answer

Fillers are a good choice for the hollow areas around the eyes. However please be careful and remember less is more around the eyes and use a product which is not hydrophilic.

Jean M. Casello, MD · Answer

It is difficult to tell from your photos if you would be a good candidate for under eye fillers.  You should consult with and experienced provider who can best advise you.  There are several products that are less hydophillic (pulling in water) that are good options for this area and result in less swelling.  The tyndall effect occurs when the product is injected too superficially.

Fechner MD Plastic Surgery &amp; Medical Spa · Answer

This is a great question! The delicate area around the eye requires special attention. Typically we may treat this area with a combination of Botox/Dysport and filler. Which filler you use as well as the provider injecting it is very important. Because it is a delicate and challenging area, be sure you go to a reputable practice who knows how to treat this area with the appropriate level of expertise and caution. Fillers that tend to "swell" less are great choices for this area, such as Restylane Refyne. Keep in mind, whenever you poke the skin with a needle of any size, you may bruise. Because the eye is so delicate, this area is prone to bruising, but not always. Taking arnica, avoiding blood-thinning medicines,and applying ice after the treatment will help prevent and quickly resolve any bruising. As an alternative to filler or Botox, you could consider treatments that help improve collagen production in this area, such as PRP injections or Ultherapy. These treatments can also be very effective at treating the area around the eye without the use of fillers. Because we have many patients that express concerns about their eyes, but don't necessarily want to undergo surgery, we have developed an Eye Treatment protocol that is designed around individual patient's needs. This treatment typically involves the use of any combination of filler, botox, PRP, radio frequency and/or skin care products.

Shaun Patel, MD · Answer

It's hard to tell based on these photos if you are a good candidate for undereye filler. In patients with volume loss and prominent tear troughs, hyaluronic acid based fillers like Restylane can be used to correct this volume loss. A small amount of filler should be used and the filler should be placed deep to minimize swelling and Tyndall. I use a blunt tip microcannula to inject the filler in this area which also reduces risk of bruising, swelling and vascular injury from the filler placement.

Gerald Pierone Jr., MD · Answer

Hello and thanks for posting.
One of the most significant areas to treat with facial fillers is the under eye region. A small amount of filler, when done properly, can erase years of aging and make one look less tired. The learning curve for injectors for this region is very steep and this makes it an advanced injection territory. 
  
However, even when the under eye region is filled by an expert injector some people will develop intermittent puffiness that is likely related to fluid retention due to the hydrophilic nature of some HA fillers.  One way to lessen the chance of this complication is to use HA fillers with less of a tendency to absorb water. Personally, I use Juvederm Vollure – 50/50 blend with the HA filler admixed with an equal amount of 1% lidocaine.  I learned this technique from the renowned Canadian plastic surgeon Arthur Swift and it has produced excellent results. 
  
But there is an alternative to HA filler for rejuvenation of the under eye region. Smooth PDO threads inserted into the tear trough will stimulate collagen production as the thread is reabsorbed. With this option, the HA-filler fluid retention issue is not operative.  The results are not as immediate, and it may take a number of treatment sessions to produce results, but the improvement is durable and very natural appearing. Because of the network of capillaries and veins in the under eye region I use PDO threads deployed by cannulas instead of needles to minimize the risk of bruising. 
  
I hope that this information helps and best of luck to you!

Amiya Prasad, MD - Account Suspended · Answer

Thank you for your question. You are asking if you can benefit from filler treatment for hollowness at the periorbital rim. You add that you want to avoid retaining fluid, as well as getting a Tyndall effect
I can certainly help guide with your submitted photo for reference, and without the benefit of a physical exam. As a facial cosmetic surgeon practicing in Manhattan and Long Island for over 20 years, I focus on facial rejuvenation due to aging, using the full range of surgical and non-surgical treatments, from all types of facelifts, eyelid surgery, to non-surgical treatments like lasers and cosmetic fillers.
To answer your question, yes, filler can be applied for hollowing at the periorbital rim, while avoiding a Tyndall effect. However, filler is usually not applied in isolated areas, so it may need to be applied in the adjacent under eye area. A softer filler like Restylane can be applied under the eyes. However, if you don’t have the cheek volume to support the filler, results may look puffy and unnatural. It isn’t clear from your images if you lack cheek volume, but cheek volume does diminish with age as we lose bone, muscle, fat, and soft tissue. If cheek volume is needed, I would apply a thicker filler Juvederm Ultra Plus or Juvederm Voluma at the bone level so it looks natural, so the transition between the lower eyelid and cheek looks continuous and natural.
I suggest you meet with cosmetic surgeons to have the whole eyelid-cheek junction examined, then exact treatment can be determined for you to look your best. I hope you found this information helpful. Thank you for your question.

Would my hollow periorbital rim benefit from filler? (Photos)

Answers (10)

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