What can be done about uneven under eye correction? My photo right eye has a deep channel (photo)

Question

My cheek and undereye filler (Restylane) photo right side of my face is not the same as the left Under my right eye is a deep channel/indentation. The doctor can not seem to make the correction match. People keep asking am tired due to the indentation. Any suggestions?

Nelson Lee Novick, MD · Answer

At least from the photo provided, it appears that you have a "shelf" under your right eye and perhaps even a suggestion of the unwanted, bluish Tyndall Effect from injection of the filler too superficially within the delicate under eye tissue. The indentation is actually result of the fact that there is simply too much elevation from the injected filler, and there is not the ideally smooth transition between the cheek and the under eye region. If this is so, two comments are in order. One, plain Restylane is seldom used for this region these days, since there are more suitable materials that have come to market. Even when Restylane was used, many experienced physicians diluted the product to make it more appropriate. Today we use Restylane Silk or Beletero Balance, the latter being my favorite for this region in my NY practice, since it is associated with little to no chance of engendering the Tyndall Effect. (In my Israel satellite facility, where a far greater number of regulatory agency approved products are available, I typically choose Teosyal Redensity II or Aliaxin FL. Since the under eyes are an area required advanced injection skills, I would suggest consulting with a board certified aesthetic physician with expertise and experience in treating this area. If deemed necessary, the currently injected filler can be dissolved with hyaluronidase and the area then retreated appropriately. Make sure to ask to see the treating physician's before and after photos before agreeing to proceed. Best of luck.

Amiya Prasad, MD · Answer

Thank you for your question. You submitted a single photo with an arrow pointed to your area of concern. You state the under eye correction you had with filler is unequal, and your doctor is unable to fix it, so you’re looking for guidance on what to do.
I can share with you my approach to patients like yourself, without the benefit of other views and a physical examination. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. Helping people with the under eye area from puffiness, hollows, and facial aesthetics with both non-surgical and surgical solutions are a big foundation of my practice for more than 2 decades. I’ll share with you first how I counsel my patients when I evaluate them for rejuvenation in this area.
To begin with, I take photos, from the front, 3 quarters views and side views and help patients understand that when they look in the mirror and they see a hollow under the eye, well very often,  it’s also in the context of the face also having relative asymmetries in terms of the relative prominence and projection of the cheekbones. And that’s a very important factor. Because when I look at someone, when I look at the eyes, I just don’t look at the eyes. I look at the eye as they relate to the cheek area and this can be very helpful in planning a strategy that can optimize the rejuvenation.
When I look at your face and the area you point the arrow where you’re concerned about the asymmetry and the indentation, I notice the cheek area and the eyelid to cheek junction has less volume in the most prominent part of the cheek called the malar eminence. I help educate my patients about this because when you use a filler like Restylane in the tear trough which works extremely well, if there is no support in cheek volume, it’s like sitting on a ledge, so you can have these elevations, and relative indentations. What I frequently do is combine the filler under the eye with a filler on the cheeks, looking at the eye and cheek as one continuous area. 
We use a method called Structural Volumizing for the cheek area which is important because we’re trying to correct the volume at the bone level. It’s also important to correct volume at the deeper fatty compartments of the cheek as well. This way it looks more natural, blends without creating surface irregularities, and does not look overdone, which is the art of doing this. That’s a suggestion for you to explore, not to necessarily just keep adding volume along this rim, but to also consider augmentation in that cheek area to balance out with the other side. 
There is nobody who has a perfectly symmetric face, so what I explain to my patients is we’re beautifully imperfect. However, it’s understandable if there’s an obvious difference that’s drawing the attention of people around you, but that’s not productive, so you want to do something about that. 
If your doctor is unable to assist you, find a cosmetic surgeon who knows this area very well, and does a lot of fillers at the under eye and cheek areas. With technique, there are many different ways to use these injectable fillers. The way I do these procedures with blunt cannulas and my understanding of anatomy as a surgeon has given me a certain perspective that’s different from someone who hasn’t operated in this space, from people who treat at a more superficial level, not naming specific specialties. I certainly feel, from my perspective as a surgeon, that Structural Volumizing and these compartments around the eyes, has been definitely successful with this. I think that is a key to helping you maximize the symmetry you’re seeking.
Meet with qualified, experienced doctors in this area and learn about your options. I think you should be able to get an improvement. You may need to dissolve a little filler, but I don’t think it would be necessary. The key is to have as good of a balance as possible. The take home message here i, understand how the eyelid and cheek are really connected, and how enhancement can create a more balanced appearance. I hope that was helpful, I wish you the best of luck, and thank you for your question.This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.

Faiyaaz Kalimullah, MD, FAAD · Answer

Thank you for your question and for submitting your photo.  While I can't make an exact diagnosis without assessing you in person, based on your photo, it appears that your injector may have placed too much Restylane under the right eye, resulting in a ridge of filler.  You also may be experiencing the Tyndall effect, a bluish discoloration of the skin that can occur when hyaluronic acid fillers are placed too superficially under the skin.  The ridge of filler is likely creating the impression of an indentation above it.  The under eyes and tear troughs are among the hardest areas to treat with fillers - injections here really should only be performed by experienced cosmetic dermatologists or plastic surgeons.  You may need to have some of your Restylane dissolved with hyaluronidase.  Best of luck!

Michele S. Green, MD · Answer

It appears that the under eye correction can be fixed by adding a small amount of filler into the other eye.  I am not sure if you had filler placed in that eye as well since it may need to be dissolved as well with Vitrase if placed too high.  You might benefit from Botox and eMatrix as well under the eyes. Please consult an expert in under eye fillers.  Best, Dr. Green

Katrinka L. Heher, MD · Answer

Judging by your photo, placing Restylane slightly higher right in the indentation should lead to a nice contour. It may be helpful to consult with another physician, and possibly an oculoplastic specialist who does this very often. Best of luck.

What can be done about uneven under eye correction? My photo right eye has a deep channel (photo)

Answers (5)

Answer: Correction of Under Eye Filler

Answer: Correction of Under Eye Filler

Answer: Uneven

Answer: Uneven

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Our mission is to create a world where every investment in modern beauty is Worth It.

What can be done about uneven under eye correction? My photo right eye has a deep channel (photo)

Answers (5)

Answer: Correction of Under Eye Filler

Answer: Correction of Under Eye Filler

Answer: Uneven

Answer: Uneven

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Recommended reading

Everything you need to know about Restylane

Our mission is to create a world where every investment in modern beauty is Worth It.