There are several things you need to understand about these services.First-under eye circle treatment with hyaluronic acid filer is the state of the art treatment for this area. It is far better than surgery, and much more predicatable than fat grafting. Second-As great a treatment as this is, it is a fussy treatment. You are asking a physician to sculpt you with the hyaluronic acid fillers. Unfortunately they do not teach sculpting in medical school. Rare doctors are very good at this. Many doctors lack the skills and talent to pull these treatments off. Even in the best of hands, about 30% of these treatments need to be adjusted to have the product sit correctly in the lower eyelid and not look like a treatment.Third- To accurately estimate volume, a physical exam of the bony orbital rim is essential. The shape of the bony orbital rim varies. In some it is right there and it actually makes what looks like a bump or a bag in the eyelid. That is favorable for filling because the bone acts like a backstop. In others, the bony rim rolls off into the orbit. Rims shaped that way require much more product because the bone does not act like a backstop. I estimate that you need about 3 ml of hyaluronic acid filler for this.Fourth-Which hyaluronic acid filler is critical. There are many brands and filler products. It makes some physicians head spin. It is not that all these products are really needed. The manufactures are cynically involved in channel stuffing to maximize their profits. Doctors often do not really understand how these products work and simply take the manufactures sales reps at their word. What product is used is critical to get a good result. I only use Restylane in the lower eyelid. The so-called smooth fillers are runny. They do not stay where they are put. They are designed this way because manufactures understand that many injectors are not good at placing products and the smooth fillers reduce the likelihood of lumps and bumps. While that sounds good, it also means that fillers will end up in the wrong place. I prefer fussy fillers that put a premium on sculpting and stay where placed. This avoids the risk of post-procedure ridges which can be seen when using products like Juvederm, Belotero, and Restylane Silk when treating the under eye circles.
