Fixing below the eye hollowness: fillers or fat?

Just saw a PS who is very experienced with fillers - he said you should never do fat under the eyes, wants to use 10 syringes of Artefill over 2 or 3 treatments. After reading, many people say not to use Artefill under the eyes, yet he seems to do it all the time and he has great reviews. Also after reading today, 10 syringes now seems like a lot. So, fat or Artefill? I don't want a temporary filler. PS: I have orbital rim and cheek implants if it matters.

Doctor Answers 3

Fillers under eyes

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Fat or HA fillers are the best way to fill around the eye.  Surgeons who do not do fat around the eyes will often say that it doesn't work or doesn't look good.  This is not true.  It can provide a very smooth, natural appearance to the eye area.  Artefill is not recommended around the eyes as it can cause granulomas.  ANd you are right to be concerned about 10cc of artefill.  That is a lot of fill to put around the eye, and I am assuming will be quite expensive.  Get another opinion.

Coral Gables Oculoplastic Surgeon
5.0 out of 5 stars 31 reviews

Undereye Hollows

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Fat is a great filler as it can last a significantly long time, however there can be complications and they are tough to fix.  I used to do fat all the time in this area until some of the newer fillers such as Voulma came to the market.  With almost not downtime these fillers can give you significant improvements with very little complications.  I would suggest not using any permanent filler in an area of an implant, there are risks of infection and biofilm formation.  Seek a cosmetic dermatologist or plastic surgeon with experience.  I wish you the best of luck, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 207 reviews

Under eye hollows fat or filler

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Fat is unquestionably the gold standard for producing the longest lasting most natural results for volume replacement around the eye based on my 15 year experience on hundreds of patients.  The main risk with fat are technique related and poor technique can result in lumps and bumps.  This can best be addressed by using a surgeon who has a very large experience.

I do not have any experience with artefill, but I have used other permanent fillers in the past and I have a few concerns.  Artefill use in the united states is still only a few years and the true complication rate of granulomas is not really determined as they can take years to develop.  We routinely see that other permanent fillers injected many years ago will take on a lumpy look as the surrounding tissue thins with aging.

We have used hyaluronic acid (HA) fillers in the eye region with tremendous success since 2005.  We find that typically the result will last for years.  One of the interesting things we have discovered is that about 3-5 years after the (HA) injection we have a significant number of patients developing swelling where the HA was injected.  This goes away when we treat the area with hyaluronidase to dissolve any remaining HA.  This is not a widely reported complication but we see it every day.  It makes the point that you do not know what is going to happen over the next few years with new fillers and do you want to be part of the experiment. The advantage if HA is that we do have the ability to dissolve it should an infection or granuloma or vascular compromise occur.  This safety net is not true of the permanent fillers.

Mark Glasgold, MD
Highland Park Facial Plastic Surgeon
4.5 out of 5 stars 47 reviews

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