Dear Dr. Seckel, Wow, it is refreshing to see such a well-informed site! It seems I have, ‘Naso-jugal Fold or Tear Trough Deformity-the True Dark Circle Under the Eye’ to use your words. I am not sure if you cover this topic under blepharoplasty in your book which I just ordered, but why are the fillers, namely, Restylane not one of your favorites under the eyes? If no vision problems are first observed, are there possible long-term risks to the eyes? Are there other substances, within Restylane beside Hyaluronic Acid that are dangerous to the eyes in your opinion? Many thanks. Michael, NJ.
Dear Michael,
The eyelid rejuvenation procedure called blepharoplasty with arcus marginalis release and fat grafting or tear trough implant is a permanent, aesthetically pleasing and usually successful correction for dark circles under the eyes and correction of the tear trough deformity. I do this operation with a laser through a transconjunctival incision inside the eyelid with a procedure called a transconjunctival laser blepharoplasty with arcus release and fat repositioning.
All fillers like Restylane are a temporary solution that needs to be repeated every 6 months-they don’t fix but camouflage the problem.
I do not inject fillers around the eyes because an inadvertent injection of filler into one of the feeding blood vessels can destroy the eye and cause blindness. In addition an infection following filler injection around the eye can cause a pan ophthalmitis and destroy the eye.
I am sure when people sign an informed consent for soft tissue filler around the eye they have no idea that they can lose their eye. Yes it’s rare-but if you are that one in a million it happens to then it is 100%.
The other problem with filler injections around the eyes is that every patient I have spoken with has not been happy with the result-some have lumps on the eyelid and cheek that make the problem worse and some get no improvement I assume because the material is mistakenly injected into the deep fat.
If you can find a board certified plastic surgeon or occuloplastic surgeon who is very experienced at eyelid surgery and filler injections around the eyes around the eye and who has experience with fillers for the naso-jugal fold or dark circles under the eyes then you can consider the procedure.
I am very conservative, and happily have not damaged anyone’s eye in the 25 years I have been doing eyelid surgery. I may in the future use fillers around the eye but I will wait for the long term studies that show that it is safe and effective.
Another concern of mine is that each time you pass a needle and inject filler around the eyes you are crating a scar. Eventually repeated injections could cause a serious deformity of the eyelid called an ectropion, which is very serious.
The blepharoplasty and arcus release with fat graft works very well to correct dark circles under the eyes. It costs about the same as about 6 or 7 Restylane injections which is what you will spend after about 3-4 years of repeat injections.
For more information on blepharoplasty, dark circles under the eyes, filler injections around the eyes, eyelid rejuvenation and non-surgical facial rejuvenation read Save Your Face or contact me.
Thank you,
Boston, Massachusetts