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

Filler is a great option for undereye hollows. I avoid permanent fillers in this area as any problems that are created with the injections are, in fact, permanent and difficult to remedy. In theory fat transfer can be used in this area and many advocate it but I've found the longevity of the fat is unpredictable and you have the risk of lumps and bumps. Dermal fillers like Restylane do need to be repeated about once each year but the results look natural and any bumps or asymmetry can be remedied either with a small amount of additional filler or treatment with Vitrase. Stephen Weber MD, FACSDenver Facial Plastic Surgeon

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.

The actual bone structure responsible for the hallows one sees, is constantly changing. Therefore, a permanent solution is difficult. If the hallows are in part caused by volume loss, I prefer using a hyaluronic acid filler. If it is skin changes accounting for crepiness under the eye, I like to use a fractionated CO2 treatment. Ultimately it is a combination approach, addressing the different signs of facial aging that give a natural and enhanced result.

Based on your photos, you may be a candidate for lower eye lid filling. Our experience is strictly with Silikon-1000, an off-label filler for permanent results. The skill of your doctor is imperative when filling your delicate under eye area.Hope this helps you.Dr. Joseph

It would be great if the surgery was as good or better than the under eye filling with Restylane.  The reality is that when properly done ( and it does take a fussy injector) under eye Restylane filling is the best treatment we have for the under eye circles.  The treatment is far better than any surgery we have.  You look like you would do well with the a small volume of under eye filler.  In someone your age, treatment can last well over a year.

Hello and thank you for your question.I routinely perform
fat transfer to this area for patients in your position, who don't want to have
routine injections with filler. The fat graft lives and is potentially
permanent. I recommend that you see a board certified plastic surgeon in
consultation to get more specific answers to your questions which can best be
addressed after a thorough history and examination is performed.
Best of luck to you!

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.