Restylane Refyne under eyes 9 days ago. Is it impossible to completely remove dark circles/shadows in overcast daylight? (Photo)

Question

I had restylane injected for the first time about 6 weeks ago. I only had a total of 0,5 ml injected into tear troughs. After 4 weeks I was injected with 1ml Restylane refyne spread across my tear troughs and blending into my upper cheek area. I prefer refyne to normal restylane as it feels softer and blends better however I still dislike the way my under eye area looks in certain lighting. Is it possible to look "flawless" in overcast daylight? Add more? Im only 27 and feel that I look old.

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs.  Because of the thin nature of the tissues the undereyes can show aging and hollowing faster than other parts of the face.  Treatment revolves around a number of treatments including skin care - nightly eye creams, lightening creams, chemical peels - as well as injectable treatments with Botox and fillers.  An in-person examination would be needed to see your specific concerns but lighting and head position will always play a large role in your results.  I would visit your injector to demonstrate what you see for the best treatment option.

Aldo Guerra, MD · Answer

Thanks for posting your photos. I think you need a formal analysis with medical grade photos to really see your before and after results. In most patients, not all darkness can go away. However, your photos suggest you might need more filler or an additional procedure to resurface the skin. I suggest you see your injector and compare the photos taken there and discuss a plan to improve things for you. Best wishes, Dr. ALDO

Jason Emer, MD · Answer

I like to use a combination of fillers for the under eye area. I really like to build the cheeks with fillers such as Juvederm Voluma or vollure or radiesse and then blend the under eyes with Belotero or juvederm volbella. Sculptra long term for entire face to help build collagen is something I like to pair with any kind of filler. For better results, you should also be using proper skincare for under eyes (i.e. brightening cream and eye serum) as well as lasers, microneedling and PRP. we often also use stem cells. Please see an expert in skin care and lasers. Best, Dr. Emer

Kenneth D. Steinsapir, MD · Answer

If you overfill this area to get rid of all of the shadow area, you will wipe out the anatomic distinction between the cheek and the eyelid.  That does not help you-trust me.  On the other hand, you can benefit from more filler in this area.  You need to work with an injecting physician who can actually see and understand your concerns.

Steven F. Weiner, MD · Answer

If you are wanting improvement from your current condition, more filler is recommended. Fillers which are robust with high G prime are needed in deeper tear troughs as yours. The problem with soft fillers is they spread and don't lift as well. A nice compromise is Restylane Defyne. It has a medium G prime and also great tissue integration of softness. I always use cannulas for this injection for safety reasons and for less bruising and swelling. Keep in mind that discoloration of the skin is not improved with fillers and needs topicals and maybe lasers for best results. In addition, filler above and below the orbicularis oculi muscle is sometimes needed to optimal results.

Steven H. Dayan, MD · Answer

Dear anla90,
Thank you for your question. It is difficult to make an accurate assessment and recommendations based on photographs alone. I recommend you seek re-evaluation with your provider to discuss your concerns and possible additional treatment options. We typically advise patients to wait two weeks to see how the effects of the filler treatment will settle and then return for a follow-up visit for a touch-up treatment as needed. The dark appearance under your eyes could be due to a number of possible issues, including superficially placed filler, skin pigment changes that could be improved by other treatments such as laser, or residual tear trough deformity that requires additional filler.

Justin Harper, MD - Account Suspended · Answer

Hi anla90,I'm not sure if it is obvious under normal light but in cases where fillers are superficially placed, the area injected might look a light blue-grey, in contrast with the darker hue of a bruise. Tyndall effect can't be remedied by lasers but bruises and other discoloration might diminish with the use of lasers.All the best,Justin Harper, M.D.

Restylane Refyne under eyes 9 days ago. Is it impossible to completely remove dark circles/shadows in overcast daylight? (Photo)

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