Herniated fat pads are hereditary, you were born with it. As we age, the fat is pushed outward from the orbit, also our skin become more thinner and loses its elasticity so the fat is able to appear more prominent. Additionally, we lose medial cheek fat which creates a flatness/depression that we did not have when we were young. All these factors cause the puffiness or dark circles to appear more prominent as we age.
Fillers to the under-eye area are Dr. Lee’s most popular treatment area and most of these patients have never had lower lid surgery. Hollowness to the lower lids/cheeks is a natural progression of aging this is what makes the under-eye filler such a popular procedure. The cost for filler treatment ranges from $800-$850 per syringe based on which product is used. Treatment typically lasts approx. 1 year. If you desire to have filler treatment after lower lids surgery, you will need to wait approx. 2 months to have the treatment performed. **approx. 10% of Dr. Lee’s lower lids surgery patients return for tear trough filler after surgery; most of his lower lids filler patients are not his lower lids surgery patients
Fillers are not appropriate for everyone. Too many providers inject fillers to patients that are not optimal candidates because they do not have any alternative solution that may be more appropriate for them. If a person has visible puffiness due to herniated fat pads and lax skin, filler injections can actually make the lower lids look even puffier. The most popular fillers are HA based and they are hydrophilic- which means they draw in water. Basically, by injecting fillers around fat is like asking for the filler to become puffier over time, thus creating a swollen lower lids/cheeks appearance. People who have noticeable puffiness should consider lower lids transconjunctival blepharoplasty. The procedure takes one hour and Dr. Lee performs the procedure in the office. It’s a permanent solution, once the fat is removed properly- it’s gone! The fat will be gone and will not stretch your skin and you do not have to deal with it again. This procedure is Dr. Lee’s most popular surgical procedure with 99.99% patient satisfaction rate. Filler is ONLY appropriate for people who have hollowness or sunken appearance. Most people as we age lose fat along the cheek area and that is why this procedure is so popular. It is Dr. Lee’s most popular filler treatment but we are very selective on who it’s performed on.
Restylane is very popular for the lower lids area. However, Dr. Lee feels that Restylane has the highest tendency to create a dark raccoon like result due to the tyndall effect. All fillers can create an appearance of darkness due to the tyndall affect especially if your skin is very thin and light. Fillers are a clear gel like material but the effect is similar to the clear ocean water appearing to be blue due to the reflection of light which makes the water appear dark bluish in color. Volbella and Belotero are popular too but they do not last very long since it’s very thin and watery. Dr. Lee stopped using these products due to patients complaining that it lasted 3-4 months. Dr. Lee has tried every filler out in the market including Vollure and Voluma and he prefers the Versa filler for the lower lids area the most. It has the soft and longevity of Juvederm but less hydrophilic. Sometimes Dr. Lee will use Voluma if the patient has thicker skin.
Serious risks include blindness and skin death/necrosis if filler is injected into the blood vessels. If filler is injected into the vein, bruising, lumpiness, darkness or shadowing and appearance of even more puffiness can occur if the person has pre-existing herniated fat pads. This is why its important to go with an experienced expert with injectables.
Most people use a needle and directly penetrate the skin and inject filler to the orbital rim. The filler comes out in little beads or mounds. Then the filler is manipulated and pushed down flat so it does not appear lumpy. The problem is that the lower lids skin is very unforgiving and usually very thin so the slightest lumpiness is very visible. This is one of many reasons why Dr. Lee does not use this method. Dr. Lee has only been treating the lower lids area using the micro-cannula(a very fine, long, blunt needle) technique. The eye area is one of the most vascular area of the entire face/body. There are a lot of blood vessels and no matter how careful one is, pushing a needle into the skin and injecting is dangerous. The needle can easily penetrate the blood vessel and if filler is injected into the vessel, it can cause blindness and skin necrosis(death). Dr. Lee is one of the busiest filler providers in the country and since he performs a lot of filler treatments, he needs to make sure the technique he uses is the safest possible. The cannula method definitely takes more time but Dr. Lee will not perform filler treatments in any area (other than chin and nose) without his cannula. This is the method that Dr. Lee uses to perform his treatment(it’s very different than most):
There isn’t any downtime after our under eye filler sessions at our Bryn Mawr and King of Prussia locations. Both Dr. Lee and Dr. Castelli use a cannula for these under eye filler injections. This requires just a single entry point to reach all areas under the skin. This is different from numerous injections with a standard needle. Because the cannula only needs a single insertion point, there is less risk of bruising, swelling, and vascular issues.
After these filler treatments, patients will have a single purplish dot at the cannula entry point. This will be visible for about one week, but it is easily covered with makeup.
After your session, you can get right back to work or your other normal activities.
It’s very reasonable at $700-$1100 based on provider for one syringe of filler which is typically what is used for this treatment. The treatment usually lasts 9-12 months.
