Long-term treatment for under-eye hollows? (photo)

Most expert experienced artistic plastic surgeons have a
variety of procedures at their disposal to produce excellent cosmetic results
in the appropriately selected patient: temporary fillers with hyaluronic acid
fillers like Restylane which usually last 6 months to 1 year, micro-fat grafts
of your own tissue - 30-50% lasts permanently, and blepharoplasties which are
more than you would need at this age. There is no one best procedure that would be applicable for everyone. Each has
benefits and potential drawbacks. The vast majority of board certified plastic
surgeons with extensive experience in eyelid surgery and soft tissue fillers
would warn against using a permanent synthetic filler because of the long term
complications which can occur even years after injection and are difficult if
not almost impossible to correct.The best option in any particular patient needs to be
individualized based on desired outcome and anatomy.Following the advice of anyone who would presume to tell you
exactly what to do based on limited 2 dimensional photos and without taking a full
medical history, examining you, feeling and assessing your tissue tone,
discussing your desired outcome and fully informing you about the pros and cons
of each option would not be in your best interest. Find a plastic surgeon that
you are comfortable with and one that you trust and listen to his or her advice.
The surgeon should be certified by the American Board of Plastic Surgery and
ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS).
You should discuss your concerns with that surgeon in person.Robert Singer, MD FACSLa Jolla, California

As a cosmetic oculofacial plastic surgeon and boarded with
facial cosmetic surgery, I have been doing a lot of facial procedures and I
also have a lot of experience with the tear trough area. The hollowing at the
tear trough area is due to skin that is very thin. There was a time in my 20
years of being practice where the treatment for the tear trough area was hard
to accomplish. We used to select only a small percentage of patients to be a
candidate for a permanent silicone implant. Presently, hyaluronic acid has
become a very unique benefit to enhance the tear trough area. Hyaluronic acid injected alone can last for 6
months to year. However, the longevity of a hyaluronic acid when injected may
be different for each patient.



In our practice, we are combining hyaluronic acid fillers with
platelet-rich plasma. Being very active with the regenerative medicine field, I
have been using platelet-rich plasma combined with extracellular matrix for
hair loss and I also use it for volume correction for acne scars. For the tear
trough area, I use platelet-rich plasma because it stimulates the body’s own
vascular endothelial growth factors and collagen. Platelets are cells in the
blood that are necessary for healing. So we draw your blood, spin it and
concentrate the platelets and the plasma that is carrying it so that we can
mimic the healing response to restore quality of the skin and volume. There is a
more long-term permanence to this type of procedure because it has a real
improvement in the skin quality.



Since you’re skin is naturally very thin and you’re only 25
years old, you don’t have as of yet, age related changes. I think that the
combination of platelet-rich plasma and hyaluronic acid rather than just
hyaluronic acid alone would be a good option for you. I suggest that you find a
doctor that you trust and feel is not driven by a purely financial incentive. You
should understand what the risks and benefits are. I hope the information about
the platelet-rich plasma was helpful in your educational process. I wish you
the best of luck, and thank you for your question.

There are many treatment options. At a young age like yourself I would avoid a surgical procedure for now. Temporary fillers would be the lowest risk procedure for you. See a surgeon who performs all types of lower eyelid surgery and fillers to get an objective assessment.