Rethinking Lower Eyelid Rejuvenation
Aesthetic Plastic Surgery
The eyes are the center piece of the face and
most commonly bear the first signs of aging in the face. Most notice the
perpetually “tired” look before anything else. Traditionally, the aging eye
meant “bags” and “puffiness” that needed surgery. In truth, despite the
appearance of “bags”, the very first change is often hollowness or indentation
that happens along an area known as the tear trough. In some, this loss of
volume extends out all the way around the lower eyelid and in time this happens
in most. A complex anatomy of muscle and
ligamentous attachments to bone exist in this dynamic area where the
indentation occurs.
Better understanding of the aging process
dictates that we should fill the area of volume loss instead of surgically
removing tissue. Hyaluronic Acid fillers such as Restylane (safe, made of
natural sugar molecules that are already in our body, with a gel consistency)
are perfect for layering in the tear trough and around the eye to give the
lower lid a naturally rejuvenated look.
What are the risks and downtime?
Bruising is the most common and is usually seen only at the entry sites of the blunt needle. Generalized bruising is rare but can occur and takes a week to ten days to resolve. The extent of swelling is variable but it is most pronounced during the first week. We suggest a regimen of Arnica and
Bromelin starting the day prior to the procedure and ask that all medications or supplements which can promote bleeding be stopped two weeks prior. Irregularities can be seen in patients with extremely thin skin or very deep tear troughs. The use of smaller blunt needle has decreased their occurrence.
Is the procedure painful?
No. A nerve block and use of local anesthetic makes the procedure practically painless.
How long will the effect last?
The results last 6-12 months: the effect appears stable in most patients for the first six months and the loss is gradual after this. A good average re-application time to keep in mind is around one year although many patients have good effect well after one year.
What if I don’t like the results?
There is an antidote: an enzyme that once injected will selectively and immediately melt the hyaluronic acid away!
* Fillers injected in the Tear Trough are used off label.
How is it
done?
Small droplets of Restylane are placed very
deep along the tear trough and around the eye rim and massaged and sculpted
into place.
What is
unique about this technique?
Dr. Hirmand injects Restylane deep (not in
the dermis) with blunt needles, custom designed by her, as opposed
to sharp needles. This evolution in technique makes it safer by minimizing the
risk of injecting into a blood vessel or causing bleeding around the eye. It
allows precise gliding of the blunt needle through the tissue for delivery of the
filler. The blunt needle is inserted through a minute and invisible needle
hole. It has resulted in less overall bruising and swelling and better results.
The other unique aspect is that this
procedure corrects more than just the tear trough. The sculpting is planned and mapped based on
your individual pattern of volume loss not only around the eyes by also in the
adjacent areas of the cheeks and midface. The tear trough is only one part of
the picture and the whole (mid)face is lifted and regains its volume and
youthful contour.
Who is the
best candidate?
Individuals with thicker skin and minimum to
moderate indentation. Even those who have had previous surgery can benefit from
this procedure.