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Note: ASAPS cannot give advice about specific medical problems nor should answers provided by responding surgeons be substituted for a complete medical history, work-up and an in-personal medical/surgical consultation. Sorry we can't answer all questions. We try to select questions that have the widest general interest.
What is the best filler for under the eye?
Hollows at the upper cheek or under-eye area can be temporarily improved with Restylane or Juvederm Ultra. These are non-animal derived hyaluronic acid fillers, which give a soft, natural correction to facial hollows. Effects typically last approximately six months after the first treatment, but can last even longer after subsequent treatments. The newer forms of Restylane and Juvederm contain Lidocaine (a local anesthetic), so treatment is comfortably done in the office with no post-procedure down time. It is helpful to avoid aspirin-containing products for several days prior to the injections, and to ice the area afterward to minimize bruising.
If your question is referring to treating the thinning or hollowing along the inferior orbital rim, I can tell you my most common current choice is Restylane.
I would recommend you seek in-person consultations with board-certified plastic surgeon members of ASAPS located in your area, and request their opinion based on their examination and their own experience. Blepharoplasty (eyelid lift) or cheeklift may be more appropriate for you.
I would recommend avoiding permanent filler materials. I would recommend considering fat graft as an alternative if you are considering other facial surgery at the same time. Discuss these alternatives with your surgeon.
Any filler can be used under the eye. Each has advantages and disadvantages. The problem is that the area is very unforgiving. For this reason, the person administering the filler should be very experienced. Fillers here should not be put close to the skin except for rare problems. Instead, they should be placed deep near the bone. Care also needs to be taken not to inject any of the vessels, as the filler could migrate to the vessels of the eye causing blindness. Because of this, I use a blunt injection needle.
Lower blepharoplasties with transposition of the fat to the hollow areas will likely provide the longest lasting correction. Short of surgery, any of the fillers can be used. However, the skin of the eyelid is very thin and may show lumpiness or irregularity. Thus, make sure the injector is very experienced with using fillers in this area and that the filler is placed deep, near the bone, to try to avoid an unacceptable result, which may take months or longer to resolve. Also, care should be taken to avoid an intravascular injection, which can lead to skin necrosis (loss) or blindness. I prefer using Radiesse, which lasts clinically about one year, for augmenting this area.
Both Restylane and Juvederm are popular options for under the eye fillers. I personally prefer Restylane for under the eyes because it tends to be firmer and doesn't seem to migrate as much. Overall, I've had better success with Restylane than Juvederm.
In patients who have developed deep 'tear troughs' at the junction of the lower lid and cheek, adjacent to the side of the nose, the meticulous grafting of fat harvested from the patient's abdomen, hips or thighs can build this area back up and nicely restore a more youthful contour.
As with all aesthetic surgical procedures, it is absolutely essential to customize the surgical plan to the specific needs of every patient.