Am I a good candidate for Restylane injections
in my tear troughs? Hello I am 27 years old and have noticed over
the last two years my hollows/dark circles have become more apparent. I am very fair
skin and tend to bruise easily. Am I a good candidate for Restylane in my tear troughs?
Is so how much would you recommend on each side? Thank you for your question! You submitted a photo and you are asking if
you are a good candidate for Restylane in the tear trough areas and you’re also asking
how much volume you need in each side. Well, I can give some perspective. I’m a board certified cosmetic surgeon.
I’m a specialist oculofacial plastic surgeon which means I focus my practice on rejuvenation
and reconstruction of the areas above the eyes and the face. And use of fillers and
cosmetic surgery to enhance the under eye area is something we do every day in our practice.
I’ve been in practice in Manhattan and Long Island for over 20 years. So I’ll give you
a little bit about my opinion based on the single photo you submitted. Now this in the absence of a proper physical
examination where when we’re talking about volume, we should have a sense of dimensionality.
And often, when we do an analysis of patients, we look at both front views, three quarters
view and side views. But nonetheless, with the one photo you submitted, it appears that
you have some puffiness under both of your eyes and this puffiness is probably what’s
further accentuating the depth of the tear trough area. Now the question that I always want to answer
when I look at patients who have puffiness under the eyes, before I do the injection
of Restylane or any hyaluronic acid (HA) filler is how much puffiness is there. How much is
the volume? You see the puffiness is representative of something called lower eyelid fat prolapse.
This means that the fat that’s normally around your eyes, pushes forward and creates
a hernia or herniated fat. Now in my practice, anybody who has a very
small amount of puffiness and is really not that bothered by that puffiness that much
is generally a good candidate for a hyaluronic acid filler to enhance and soften the transition
between the fat prolapse and the valley of the tear trough area. You see, if you think
about the contrast, the higher the mountain, the deeper the valley. So, if the puffiness
is slight and the valley is not as deep and it becomes something that is achievable with
hyaluronic acid filler. Unfortunately, a lot of people become a little bit too ambitious
and use the same fillers for people who are very puffy. As far as volume is concerned, I think it
is safe to say that you would probably benefit from 1 syringe. 1 syringe of Restylane or
a lot of other HA fillers is about one milliliter which is equivalent to one baby teaspoon.
If placed strategically, you can get certainly a very nice result and get even more evenness.
As far as the exact numbers are concerned, that is really something that is hard to estimate
without physical examination and seeing how your tissue responds. I always try to explain
to our patients that when people look for solutions, they often look for a name of a
technology. Let’s say it’s a machine or an injectable like Restylane but really, it’s
the judgment of the physician and the style and the method and the artistry that makes
all the difference in the world. It’s often said in surgery that a good surgeon can work
with any type of instrument and being a practicing surgeon for over 20 years, I can certainly
attest to that. The same applies to injectables. But one of
the things that is specific to injectables is it’s also about how the patient responds
to the injectable and therefore, in a case scenario where a small amount creates a certain
amount of swelling, well there’s fluid that also compensates for the volume of the filler.
So there’s a lot of finesse. Another take home message is that when you work with the
doctor and you feel comfortable, stick with that doctor. What I always say that we are
like primary care doctors for beauty in our profession. At least in my practice, that’s
how I treat my patients. So getting to know the individual patients
and putting a certain amount, seeing them and follow up in two weeks gives me a better
sense of how they respond and what kind of volume they need. Some people need more, some
people need less. So I think at this point, meet with qualified,
experienced surgeons is my bias because I think that a surgeon understands what to do
with fat pockets under the eyes as opposed to a non-surgeon who may be biased by their
lack of ability to do the surgery to always advocate for injectables. It’s not the nicest
thing to say but unfortunately, that’s the reality. There is a lot of bias and a lot
of territorial protectiveness in the medical field and particularly in the cosmetic field.
So I think the doctor who’s very skilled the full spectrum of solutions to me has the
advantage over let’s say a non-surgeon like a dermatologist who doesn’t do this type
of surgery. Dermatologist may do other surgeries but typically, they don’t do lower eyelid
blepharoplasty. So I think that finding that doctor that you’re
comfortable with and then going through this process, you’ll learn a lot and be able
to answer this question that you submitted. So I hope that was helpful, I wish you the
best of luck and thank you for your question!