Restylane for Hollows in Lateral Part of Eye Orbit?

Question

I'm South Asian and have inherited dark hollows around my eyes.  There's little collagen so the skin is thin and also dark pigmented. I'm 19 and considering Restylane filler.The before and after shots of people that have taken Restylane in the eye area mostly correct the troughs and I haven't seen it used on the lateral circumference around the eye and to blend into the outer part of upper eyelid (near zygomatic bone).Has this been achieved with good results?  Any other advice to fix this problem?

Stephen Prendiville, MD · Answer

In my personal opinion, Restylane (or other form of hyaluronic acid injectable) in the infra orbital hollows is a procedure searching for an indication.  I have literally never seen any results I have been pleased with in my own hands, or in the hands of other surgeons.  The best result yields a quasi-allergic infra orbital puffy look, the worst result leads to a bluish discoloration known as the Tyndall effect.  The reason for this is that the preorbital and preseptal skin are very thin, and closely associated with muscle, which in turn overlies orbital septum and fat.  The margin for elevation is rather small in these areas.  
My advice is use caution in considering use of any form of injectable in the periorbital area (including fat).  You may want to start with some form of topical agent containing Retin A for skin cell turnover and/or hydroquinone (minimizes pigmentation on a temporary basis)

Young R. Cho, MD, PhD · Answer

I do use Restylane under the eyes and I do inject laterally with some success.  If the patient is coming because of dark shadows under the eyes, then I try to help them understand that fillers may soften the shadows somewhat by filling in depressions.  I also explain that skin laxity under the eyes may cause what appears as a concentration of pigmented skin and hence appear darker and hence surgery may be an option.  If there are no hollows to correct and skin is not lax, then I would be recommending a lightening agent such as hydroquinone or Lytera to lighten the region under the eyes.

Ron Shelton, MD · Answer

The photograph reveals dark circles of skin above the muscle in the orbit. This is not a very safe area to inject Restylane or any filler. It is used more safely under muscle when this is above the bony area of the high cheek bone. Dark circles may benefit by laser resurfacing, although there is a risk of darkening (post inflammatory hyperpigmentation), vitamin K creams and in some people, who truly have darker pigment – lightening creams.

Joel Schlessinger, MD · Answer

While this area sometimes responds very nicely to restylane, it can also have major problems and require redos or removal of the product. You may want to try something over the counter like Obagi's ElastiDerm (http://www.lovelyskin.com/details.asp?PID=116059), which works quite nicely and helps with these without major injections, etc. While it won't lift, it does seem to help with the darkness. Good luck.

Kenneth D. Steinsapir, MD · Answer

Dear Reveena
I treat a large number of young actors for under eye hollows and dark circles. This is an excellent option. While the treatment is safe for those trained in eyelid and midface anatomy, the methods is highly technique dependent. Translation: this is basically an art form. The treating doctor is sculpting your face with Restylane. It is my personal opinion that Juvederm is not the ideal product for this application. In my experience the feature that prompts the marketers to call Juvederm "smooth" also means that it does not hold as well as Restylane in the under eye area. However, I think that there is room for disagreement on this point.
The other issue is that this treatment does not eliminate the dark ring around the eye, it simply makes it look better. However, this improvement is generally welcomed and I encourage you to find an injector who is well qualified for these types of treatment.

William Ting, MD · Answer

Either Restylane or Juvederm would be a good option for tear trough deformity, including lateral portions of the lower eyelids in the hands of an experienced board-certified dermatologist or plastic surgeon. This would be an off-labelled indication that has had good track record for the past few years. Some physician injectors may choose to use 1" 30 gauge needle to minimize number of pokes to ensure minimal risk of bruising.

Steven Hacker, MD · Answer

Although this is effective in many cases in the "tear trough" area, it is risky and only should be done by an experienced surgeon . This can result in visual lumpiness in this area because skin is so thin and if placed to high it will not be cosmetically acceptable. For these reasons, I often discourage patients from doing this area.

Eugene Mandrea, MD (retired) · Answer

Restylane in the lateral part of the eye orbit works provided that it is done very carefully.
The technique is unlike that in the medial part of the orbit (Tear trough), where a fair amount of Restylane (0.2-0.3 ml) can be injected deeply under the muscle.
For the lateral side, I inject very tiny amounts (0.05ml) superficially. If, after massaging, more seems to be necessary, I inject again a tiny amount.
This is not for beginners.

Restylane for Hollows in Lateral Part of Eye Orbit?

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