Thank you for your question!
You stated in your question that you had Juvederm injected under your eyes and that you are
concerned about some lumps and the appearance of hollows and that your cheeks look sunken.
You’ve reached to your doctor who said that it’s important to let it settle and of course
you are very concerned about your appearance and you submitted photos to help support your
question.
Well, I can certainly help assist you with your question.
I’m a board certified cosmetic surgeon and fellowship trained oculofacial plastic surgeon.
The oculofacial plastic surgery fellowship training is after first training in eye surgery
and specializing in cosmetic and reconstructive surgery of the eye area.
So you can imagine I have a lot of experience practicing for over 20 years in Manhattan
and Long Island with helping people improve the appearance of their eyes.
So this is a type of situation I come across a lot and it is in no way a criticism of your
doctor but I think one of the things that is a challenge in your situation and this
is only limited based on the photos you submitted, is that you are dealing with several issues
concurrently and the under hollow was obviously the issue that bothered you the most that
brought you to the doctor who then addressed that specific issue.
When people come to my practice, one of the things that I do is I go down a list of their
priorities and our consultations, we take a lot of time.
This is one of the most important things about helping people is to hear the problems and
understand the context.
And in many times, when one looks at themselves and they look at an area very critically,
they often lose the forest for the trees.
In other words, they look at something and we all do this.
We all look at something we don’t like, we concentrate on it and it magnifies.
And now, you have that somewhat addressed, now you’re looking at the big picture.
So when people come with concerns about under eye hollowing.
We have to first define what is the cause?
Is it a genetic thing or is it facial aging or is it both?
When I talk to my patients about facial aging, I explain that there is volume loss, bone
muscle and fat and it’s not limited to one area that you’re looking at.
It’s more global throughout the face.
And there is sagging.
So in a situation like yours, I have been helping a lot of patients by also looking
at the frame around the eye, the cheek bones, and the space around the eye.
And so a lot of times, we will approach this problem in a couple of different ways.
One is to do similarly as what your doctor did is to use a filler such as Restylane which
I prefer for the under eye hollows and I will combine that with a skin quality treatment
called platelet-rich plasma (PRP).
Now I’m saying that because when I look at your photos, your skin looks relatively
fine and thin and so I will also identify that for the patient and have them consider
that as a way to synergize between the volume correction and skin quality.
Now platelet-rich plasma is derived from your own blood and it contains the healing and
growth factors necessary for wound healing.
And in our practice, we use it a lot and we have been able help people with skin quality.
Now on top of that, I also ask people to step back and often take pictures and show them
that the cheeks which you described as sunken is probably also an opportunity to improve
the under eye hollowing.
You see, when you look at the side view or you look from the front, you can see that
there is a flattening effect at the eyelid to cheek junction which is a ledge.
So you can imagine, putting a volume filler on that ledge, it can be difficult to make
to make it look really good.
So in some patients, we offer a procedure like a Y Lift and not necessarily the entire
lift.
We use a filler such as Juvederm, Ultra Plus or Voluma and we place it on the cheek bone
in a very specific method and we don’t necessarily do the whole thing such as the jawline and
everything else but at least so a cheek lift.
And a cheek lift with the under eye hollow being corrected is a very nice combination.
So I think your doctor is on the right track certainly by advising you to wait because
at the beginning, it isn’t unusual especially with people with thin skin to have these types
of lumps.
In our practice, we see our patients after 2 weeks to reassess and I wait the 2 weeks
because that’s how long it takes for the material to settle and for the body and the
muscles to massage the material in a way into its contour and that’s an opportunity then
to maybe enhance or add.
On top of that, think about how the cheeks, if the cheeks have a role in this overall
look and then there may be an opportunity to improve the appearance of your eyes by
enhancing the cheeks.
So I think you should speak to your doctor who performed this procedure about this type
of option and learn more about figuring about how to get the whole area to look good instead
of just the isolated area of the tear trough because you might see if your doctor took
before and after pictures that there is an improvement but no one looks at you and says
“Oh your tear troughs look really good today.”
They look at you and say “You look good today.”
And so we have to look at the whole picture and not just the little areas we focus on.
So I hope that was helpful, I wish you the best of luck and thank you for your question!