How Slightly Puffy Eyes Can be Treated with Fillers, & Addressing the Cheek Area for Better Results

Surgery or Restylane for 35 yo? I am interested in improving the appearance
of my under eye area. In my case, would you recommend Restylane injections or would surgery
be necessary? What would be the recommended procedure? I am 35. Is it likely that the
Restylane option might worsen the appearance of my eyes in the long run, after its effect
wears off? Thank you for your question! The age of 35, you have submitted this single
photo where you’re asking whether to do surgery or to use Restylane. And then you’re asking
whether or not Restylane can affect the appearance long-term. So certainly, you have a very legitimate
question. In the modern world, there are certainly more than few options to consider when it
comes to hollowing and puffiness under the eyes. So before we define the solution, let’s
define the problem. At the age of 35, with the photo you submitted,
it appears that you have very thin face and there’s a combination of a slight bulge of
puffiness under the eyes that represent something called lower eyelid fat prolapse. Lower eyelid
fat prolapse is the fat around the eye kind of herniating forward and pushes forward slightly
to the point where it looks puffy. Now paradoxically, adjacent to the puffiness
is a relative hollow and there are two areas where the hollow is manifested. One is the
tear trough area. That’s the area just adjacent to the puffy area. And below the tear trough
area is called the eyelid to cheek area sometimes referred to the V deformity. Now this is when
the bone around the eye called the orbit. It previously had a little bit of fat over
there and the fat diminished and it’s thinner so you see more of the bone structure. Now
if you’re already a very thin person, this is something that tends to happen then you
get this overall hollowing appearance. So you have a couple of options. And one of
the things that I do is that I explain to my patients of how they would look when we
address the puffiness under their eyes. But understanding that the overall appearance
of their eyes may require more than just the reduction of the puffiness. We would often
combine the surgical procedure with platelet-rich plasma as well as restylane and fillers at
the time of the surgery or later on. Now when people are at the threshold and I
think you fall in that category although I can’t see a side view of your eyes, when there’s
only a slight puffiness, we can always do a trial where we strategically place some
restylane, a hyaluronic acid filler. I often combine it with platelet-rich plasma and I
find that the benefits of blood supply improvement as well as quality of the skin act synergistically
with the volume benefits of hyaluronic acid. I think it’s reasonable to do a trial in using
this filler if it’s done well and see if you like the look. And if you like that look then
this something you can maintain by doing this once or twice a year depending on how your
body metabolizes the filler. Now if the filler does not help adequately enough then surgical
procedures may be the next step. Again, it’s all about communication and understanding
what would be the results afterwards. I typically address the eyelid-cheek area.
As a facial cosmetic surgeon who performs face lifting, cheek implants, facial rejuvenation
surgeries routinely, I look at the eyes and their context to the whole face. Very often,
it’s a strategy about balance of doing not only the focal area of the eye but also to
enhance the volume of the cheek. Now it doesn’t mean you want to look like a pillow or overdone
but I always make a distinction between correction versus augmentation. When we talk about volume
loss and aging, we’re talking about correction. So I think at this point, the best thing for
you is to meet with a qualified and experienced cosmetic surgeons who focus a lot on the eye
area and see who you resonate with and start exploring these options. I think the very
safe option is to do the injectables first step. The nice thing about hyaluronic acid
is that there’s an enzyme called hyaluronidase to dissolve the material if it turns out to
be in excess that causes more puffiness. But it’s a good first step and I’m making this
recommendation based on that single photo. So a 3-dimensional examination certainly has
considerable advantages than reviewing a single photo. So I hope that was helpful, I wish
you the best of luck and thank you for your question!

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