Are restylane under eye hollows, are fillers under the muscle safer?

Question

Hello everyone Is injecting filler under the muscle as an eye hollow treatment safer than above the muscle? I am especially concerned by the risk of injecting filler into a blood vessel and which technique is better in order to avoid this. Also: do face exercises speed up disolving the filler? Thank you very much!

Philip S. Schoenfeld, MD, FACS · Answer

Your question is a very good and specific one.  Most patients do well with injection of Restylane underneath the muscle as this elevates the muscle into a less concave position so that the hollowness of the eye is alleviated.  In some cases injection above the muscle needs to be done as well in order to fully correct the hollowness of the eye.  The use of injection canulas have helped to decrease the incidence of bruising but there is no data on vascular complications with the use of canulas or injection above or below the muscle.  Slow injection and injector experience with a very good knowledge of the anatomy are the keys to a safe a successful injection into the under eye hollow.

Nima Shemirani, MD · Answer

Hi @Lili786. Most facial filler products that are injected into this area should ideally be placed in the tissue plane directly on top of the bone, or at least underneath the eyelid muscle layer. If a facial filler product is placed too superficial in the skin, or on top of the muscle layer, the product may settle in with an abnormal appearance and can look to be lumpy, swollen, or irregular. Best of luck, Dr. Nima.

Jason Emer, MD · Answer

At home peels like cosmelan, enlighten and aerify along with dermarolling (MTS roller with anteage MD ampules) should be started now. There are many things you can do to treat under eye hollows and dark circles. A surgical option to remove skin and/or fat will such as lower eyelid blepharoplasty with or without fat pad repositioning will be the best long term. There are many things you can do to treat under eye hollows and dark circles without surgery. Non invasive less downtime options such as fillers (Belotero, Juvederm Volbella​), lasers (Moxi/Halo/Fraxel/CO2​), Renuvion (J-Plasma), microneedling/PRP, stem cells and microneedling RF like Fractora PiXel8 or Morpheus can all help give some improvement. Accutite can often be used or stronger lasers like erbium or co2 spot treatment can tighten the skin and give very quick improvement in wrinkles and texture. A surgical option to remove skin and/or fat might be the best solution long-term. I suggest you get a formal consultation to see what is best for you and your goals. Best, Dr. Emer.

Aldo Guerra, MD · Answer

Hello Lili.Under the muscle is preferred with thicker fillers that create "lift" of sunken under dark circles. For thinner fillers then above the muscle is acceptable, but these fillers are for less noticeable depressions in the tear trough. There's no evidence either approach reduces or increases the risks of vessel penetration and embolism. Concensus on reducing vascular complications includes injecting with minimal pressure, injecting low volume at a time, and moving the tip of the needle or cannula frequently. Using cannulas might be better, but it hasn't been proven.Best wishes, Dr. ALDO

Leo McCafferty, MD · Answer

Caution is key before considering any filler under the eye.  You're correct in worrying about injecting filler into a blood vessel in this area.  This is very rare but at the same time can be devastating.  There are other very safe ways to improve the junction between the lower lid and the midface and I would suggest you seek the opinion of a board-certified plastic surgeon to explore these options.

Robert S. Schmidt, MD · Answer

Thanks for your question. Traditionally, fillers in this area are placed under the muscle, directly on top of the bone of your lower eye socket. There aren't any important blood vessels in this area. Because you place it in an area that isn't particularly active, I've seen Restylane last over a year in this area (in lips it tends to dissolve in 6-9 months). Check out the photo from my archives for a good example of the results from this technique.

Faiyaaz Kalimullah, MD, FAAD · Answer

This is an excellent question.  Filler placement depends on a variety of factors, including the patient's facial structure and anatomy, skin thickness, extent of volume loss, and the products being used.  I find that deeper injections under the muscle are beneficial when using thicker products to correct more prominent, deeper volume loss, while smaller amounts of thinner fillers can be used above the muscle for more shallow lines.Please keep in mind that this is a particularly complex area to treat with fillers - I would recommend seeing an experienced cosmetic dermatologist or plastic surgeon for treatment.  Best of luck!

Melvin Elson, MD · Answer

There is no difference in injecting above or below the muscle as far as extremely rare vessel injection is concerned.  the only issue is that the more superficial injection may be more likely to product the Tyndall effect which gives the area a blue hue

Steven Wallach, MD · Answer

Fillers in the tear trough are a nice thing to have done when there is a clear depression. I often use diluted restylane in this area. I find that it blends nicely.

Davin Lim, MBBS, FACD - Account Suspended · Answer

There are many techniques to treat under the eye hollows. It depends on the product used and the injector, PLUS your hollows itself. As a rule most injectors use a cannula, some a needle, but the plane is usually on the bone under the muscle. In some case we use the ' sandwich technique' ie. on bone, then above muscle. This technique is advanced, requires a cannulas, but also carries a higher risk of the Tyndall effect- ie. blue filler underneath the eyes. Be guided by your specialist. Dr Davin S. Lim. Laser and aesthetic dermatologist. Brisbane. Australia.

Are restylane under eye hollows, are fillers under the muscle safer?

Answers (10)

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