The explosion of choices for fillers and non-surgical options is mind-blowing and certainly confusing at the least. The best way to break it all down is to think of the aging process in depths.Superficial fine lines and wrinkles - These are the fine lines around the mouth, the crows feet and fine lines of the forehead.Deeper folds and wrinkles - These are the folds around the mouth known as the nasolabial folds and the marionette lines.Soft tissue atrophy or sagging - These are the hollows of the face that are not related to the skin but change as a result of aging, weight loss and gravity.The treatment for superficial fine lines and wrinkles takes on several different, but not mutually exclusive options.Good SkincareAntioxidants topically and as food supplementsRetin-A as tolerated.Sunblock (Zinc Oxide)Alpha-Hydroxy AcidRoutine exfoliation (facial scrubs, Buf-Puf or clarisonic)Chemical peels2. Fillers - the fillers that treat fine lines are those fillers with the smallest molecule size. There are two fillers available on the US market.Belotero - an excellent filler, painful to inject with a 4-6 month lifespan.Restylane Silk - an excellent filler with lidocaine to reduce pain a bit. Reported to have a 6 month lifespan, but newer so the jury is still out.These fillers should not be used as a replacement for those fillers that are designed for the deeper folds. If these are used, patients will feel that little was done for them and become unhappy patients.3. Paralytic Agents - botox, xeomin and dysport - will paralyze the muscle that make the wrinkles. They have limited use around the mouth and crows feet, so the newer fillers should rule this segment for a long time.The Treatment for Deeper Folds of the nasolabial fold and marionette lines are best treated with;JuvedermRestylaneRadiesseMost importantly, for patients with deep hollows around the eyes and loss of volume of the cheek, any of the above mentioned treatments will lead to dis-satisfaction. In my office, the ideal treatment for loss of volume is fat transfer. I use my patented Viafill fat transfer system. I replace the lost volume of fat with a patients own fat. The results are natural, smooth and long-lasting.If you would like more information on these issues or any other issue related to facial aesthetics, please read my book "A More Beautiful You - Reverse Aging Through Skincare, Plastic Surgery and Lifestyle Solutions".
Thanks for your question and we recommend that you consult with a board-certified dermatologist or plastic surgeon that are the most skilled when it comes to injections in the deep eye hollows that you are describing. Belotero is one of the best fillers to be used here by skilled injectors, and the results are usually wonderful. Other hyaluronic acid fillers can be used here, and most would use either Belotero or Restylane or the new Restylane Silk that has just been FDA approved. Again, finding the most skilled provider is your key to achieving the best results possible.
