Is getting filler in the under eye area or the upper eye are bad?

Hi, I started with fat grafting of the upper eyelid and lower eyelid area back in 2006-2009. My first upper eyelid filler was performed in 2007, but no one was doing it at the time. I followed that patient and in 2008, I did a few more while still offering the fat grafting. In general, instead of offering a surgical fat grafting to younger people, I used a single syringe to filler the brow/upper eyelid hollow. Interestingly, it doesn't take very much filler to get a nice result. Also, 0.2-0.3 cc too much or too little doesn't look good. Since the survival rate of the fat grafting is usually in the 30% range but can vary from 10-50%, I did not think this was a good idea anymore to do fat grafting of this area. Following thes patients for more than 10 years, it has become apparent to me that the filler last much longer than a couple of years. Depending on their aging and weight gain or loss, the patient may want more filler as they continue to hollow/age/lose weight. Interestingly, if fat grafting is performed and they lose weight, the fat graft will shrink. If they gain weight, this was the bigger problem, since their existing facial fat will grow along with the abdominal fat that was grafted to their face. This fat becomes problematic, and since my younger patients have many decades to live, I didn't not want to curse them with this problem. I think if the person is already older and has lost a significant amount of fat from aging, then facial fat grafting has its place. Additionally, I have encountered patients who have had fat grafting to the their brow/upper eyelid area with significant lumpiness. The filler does not work well with the fat grafts. Filling in between lumps of fat is not perfect either. The filler is injected into a fascial compartment which allows for facial movements to slide across the layer underneath. What I found with the fat grafted patients were than the fat grafts glued the upper layer to the lower layer with a clump of fat. I tried filling with Restylane around the fat grafts, but the movement of the brow fat pad was not normal. For these reasons, I have shifted and stayed with Restylane filler since 2008 for these areas. My hope in the future, is that there will be better technology which can grow back the existing fat without injecting abdominal fat into the face. At that future time, I left the door open since the Restylane can still be dissolved and the better technology can be used. I hope that makes some sense. Good luck. Best, Dr. Yang

Hello, and thank you for your question. Fillers are a great treatment option for rejuvenating the eye area, but keep in mind that it requires plenty of skill and experience to perform them safely and correctly. Inexperienced injectors can either administer too high a dosage or inject the filler in the wrong locations, leading to undesirable results. I recommend scheduling an in-person consultation with a reputable board-certified facial plastic surgeon, particularly one with extensive experience with injectables. Your surgeon can assess your skin, customize the best treatment plan (sometimes a combination of treatments is best), and ensure the best possible results.

You are correct that in general many experts in the field are becoming more cautious with filler around the eyes. The skin around the eyes is the thinnest on the entire body and very unforgiving, so in general if doing continued filler to the eyes it is usually just a matter of time until a cosmetic complication like discoloration, swelling , lumps bumps etc... will show up. I usually tell my patients that the filler has the advantages of being relatively quick and cost effective with immediate results however it does have a higher complication rate than that of surgery if one is a candidate. In the end all treatments have risks so it is best to just get consultation with someone very experienced with filler or surgery in the eyelid area and make an informed decision. Best of luck!