Dr Jennifer Allen – The Top 8 Things to Consider About Cosmetic Injections Under Your Eyes

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The undereye area presents several challenges when it comes to cosmetic injections.  First, the skin is quite thin in this area, which makes it less forgiving than other areas of the face.

Any bumps or indents in the contour due to the filler are more visible in this area.  Second, an abundance of vessels surround the eyes which can lead to increased bruising and swelling after an injection.

Being educated and knowledgeable about the various challenges, options for treatment, and nuances regarding undereye injections will help you make the best decisions for your treatment.

1. Choose the right time to undergo undereye injections. If an injector recommends that you treat your undereye region with a cosmetic injection, but you have never been bothered by your undereye region, I would consider waiting and taking time to consider whether treatment is truly something you want to undergo.  On the other hand, if every time you look in a mirror or at a photo, all you can see is undereye grooves, bags, sunken eyes or a tired look around your eye area, maybe it is the right time for you to pursue treatment options. If and when you do decide to have your under-eye region treated, you need to think about the exact timing.  If you end up with a bruise, which is possible after undereye injections, the bruise will most likely be visible for 2 weeks. Planning to get your injections done when you have a window in your schedule will help you avoid showing up to an important social or professional event with an embarrassing bruise.

2. See a doctor who has treated a lot of under-eye issues. Not all cosmetic providers treat the undereye area, and those who do have different levels of experience with the area.  With experience comes improved knowledge, insights, and techniques, so it would behoove you to have the benefit of that experience on your side by choosing a doctor who has successfully treatedmany patients with similar concerns.

3. Some under-eye issues can be better addressed through surgical options. It may be worth considering surgical options if you have certain characteristics that make under eye injections particularly challenging. For instance; loose skin, excessive wrinkling, large fat pads, or extremely deep grooves under the eye may lend itself better to cosmetic improvements with surgical measures.

4. Hyaluronic Acid (HA) fillers are the most common injectable fillers used under the eyes.    Juvederm, Restylane, Perlane, Belotero and Vollure are all examples of HA fillers. Your doctor will recommend his or her preferred HA filler to use in the under-eye area.  HA fillers have a good safety profile because they are a natural product and are temporary and reversible.  If you like the look of your HA filler, however, the temporary aspect of the treatment can be frustrating.  Although HA fillers are commonly used under the eyes, their use is not without risks.  HA fillers can create a puffy appearance if the filler absorbs water and expands slightly after treatment. While it is hard to know for sure which patients will experience this, in general, the looser and more damaged a person’s under-eye skin is, the more likely that person’s HA filler will look puffy.  Also, some of HA fillers can lead to the undereye area gaining a slight bluish hue when the light hits the person’s face in a certain way.  This is caused by the Tyndall effect.   Some HA fillers are significantly less likely to create the Tyndall effect than others, and an experienced injector will know which option to choose to minimize this risk.

5. Bellafill is a long-lasting filler used by some experienced injectors to treat the undereye region. It has several unique characteristics that can make it particularly useful in this area on the right patient.  If you are interested in pursuing this option, make sure that you see a provider with plenty of experience with using Bellafill under the eyes.  The long-lasting component of Bellafill is made up of polymethyl methacrylate (PMMA) microspheres.  This is a synthetic product that your body does not break down, thus producing the long-lasting results.  Bellafill’s long -lasting nature is a wonderful characteristic for patients who are pleased with their results.  The PMMA microspheres stimulate the patient’s body to build collagen into and around the filler, so that the Bellafill becomes a sort of living implant with the passage of time.  However, a risk associated with Bellafill is the possibility of the patient developing of a visible bump if too much collagen grows into and around the filler.  This is a rare complication that has become even more rare with developments in the filtering process of the PMMA particles.   Talk to your doctor about the risks and benefits of using Bellafill and take precautions to minimize the risk should you decide to proceed with Bellafill injections.

6. Your own body fat can be used to treat under-eye issues. Taking fat from one area of the body and injecting it into the undereye area can be a good treatment option for some under-eye issues. The appearance of facial fat is exactly what cosmetic injections are trying to emulate, so it makes sense to use the best and original facial filler: your own body fat.   Using body fat instead of filler does require a bit more set up and procedural time.  However, the results are both long-lasting and permanent, and they typically have a very natural look to them.  Like all procedures, there are challenges and risks to undergoing fat transfer under the eyes.  Fat can be somewhat unpredictable in terms of the amount of fat that stays viable after the initial healing period.  Some of the injected fat will likely not survive the transfer, and it is difficult for your doctor to know exactly how much will survive once it has been placed.  To combat this issue, doctors either overfill a little bit when working with fat, or they plan on doing serial fat transfer procedures to the same area to get to desired level of fullness.  Another possibility is that you could develop a visible bump after fat transfer under the eyes, and the thin skin of the undereye area is notorious for being unforgiving with bumps.

7. Choose a doctor who uses a cannula instead of a needle when injecting filler (or fat) into the undereye region. Cannulas can be curved or straight and are generally shaped like needles. The big difference between a cannula and needle, though, is that cannulas are not sharp on the end; they are blunt, and the filler or fat comes out of a little opening on the side and not on the end of an open sharp tip, as in the case of a needle.   It is the closed, rounded, blunt tip of the cannula that makes cannulas safer than needles. When the tip of a cannula comes into contact with a vessel, it is much less likely to puncture the vessel compared to a needle.  Vessels will roll over or under the tip of the cannula as opposed to being punctured by needles.  Cannulas cause less trauma, bruising, and bleeding than needles.  Most importantly, cannulas are less likely to allow inadvertent injection of filler into a vessel compared to a needle.

8. Injections under the eyes can be a work in progress and may require more than one treatment session. Because the area is challenging to work with, and it is prudent to be conservative with each treatment, it is not uncommon to need more than one treatment session to get the results you want.  Achieving an incremental improvement in one injection session is considered a reasonable amount of progress, even if full correction is not yet achieved.  Practicing patience while working with a doctor who is both skilled and cautious creates an optimal atmosphere for getting a good final result after undergoing undereye cosmetic injections.