Nelson Lee Novick, M.D. is a Clinical Professor of Dermatology at Mount Sinai School of Medicine in New York City, an Attending Physician, and a former OPD Clinic Chief within the department of dermatology of the Medical Center. He is board-certified both in internal medicine and dermatology and is a Fellow of the American... more
In my last blog, I discussed how natural, hyaluronic acid fillers (which are all basically complex sugars) can rejuvenate the "frame of the face" by lifting and volumizing the cheeks to recreate the ideal heart-shaped, high cheekboned look, and diminish tear troughs, smile lines, and sad lines. I also explained how strengthening the rear angle of the jaw and adding projection to the chin can straighten and define the jawline, improve sagging, diminish jowls, and create a more youthful profile. But, not uncommonly, the periorbital area, the area around the eyes, needs to be directly treated in order to achieve a really "Wow!"-evoking facial improvement.
The periorbital region includes not only tear troughs, hollows and bags under the eyes, but the crinkly and crepey skin that accompanies the crow's feet to the sides of the eyes; as well as to age-related falling brows--especially the outer third of the eyebrows directly above the rim of the upper portion of the eye socket. But why are the eyes so important? It's precise because we humans spend so much time relating to one another and trying to see "eye to eye" with each other that any, even minor, defects in and around the eyes draw a disproportionate amount of our attention.
So, even any little defect of any kind around the eyes will generally engender more aesthetic trouble than say an equal defect on the upper forehead or lower cheeks. This means that when there is an age-related problem around the eyes, it requires direct treatment if we are really looking to improve our appearance and turn back the aesthetic clock. As I pointed out earlier, simply treating the cheeks with injectable volumizing and lifting fillers usually secondarily improves the under-eye region. But, when bags, sacs, tear troughs and hollows are just too prominent or deep, the finesse use of a natural hyaluronic acid filler, such as Belotero Balance or Teosyal Redensity II can help to directly fill, elevate and smooth this critical region.
I don't generally suggest the use of plain, ordinary Restylane for the under eyes since it is more a lifting filler, which may give rise to unwanted lumps, bumps, and a bluish/gray discoloration, known as the Tyndall Effect when injected into the delicate tissue of this region. Nor do I typically recommend plain Juvederm, as this product has a well-known tendency to "grab onto" and hold onto tightly tissue fluid, which can result in distorted swellings that may later need to be dissolved. In youth, the outer third of the eyebrows in women flare upward and outward. With the passage of time, loss of supportive fat under the brows often paralleled by the loss of fat within and consequent hollowing of the temples, leads to the collapse of the outer brow and also to the secondary appearance of excess, redundant upper eyelid skin.
Reinflating the temple with a lifting filler, such as Restylane Lyft or Restylane Volyme accompanied by direct reexpansion of the brow itself with Juvederm Ultra Plus XC can restore the more youthful flare to the outer brows and diminish the sagging of the upper lids. Finally, if, after years of smiling, deep creases, crinkles and crepeyness, the skin at the sides of the eyes has become indelibly etched, this can be addressed with the use of specially formulated hyaluronic acid injectables, known as skin boosters, which, when injected very superficially throughout the whole area, promote improved skin quality by contributing to overall greater skin tightness, hydration, and suppleness. Taken together, all of the above quick and simple treatments can do much to ensure for you that indeed "the eyes have it."