PREMIUM ARTICLE PREVIEW
A number of physicians from ophthalmologists to dermatologists to plastic surgeons to family practitioners have begun to promote hyaluronic acid injections around the eyes as a viable non-surgical alternative to lower blepharoplasty. Is it?
• The Aging Process
Facial aging involves two basic processes: sagging and deflation. Beneath the eyes, the "sagging" component consists of weakened support within the lower eyelid that allows fat to protrude forward and create "bags." As a separate change in the tissue just below the eyelids (that is, in the upper cheek), a depression may sometimes form due to loss of underlying volume ("deflation") and/or a downward migration driven by gravity ("midface descent").
What results is a rim of cheek depression just below the bone known variously as the "tear trough," an "infraorbital depression," an "orbital rim hollow," or, more commonly, "dark circles beneath the eyes."
In essence, the lower eyelid sagging creates a convexity while the cheek deflation results in a concavity. One contour abnormality "plays off" the other and accentuates the difference in each other's height, like a small hill standing next to a small valley, a difference that can be made even more noticeable by shadowing.
• The Rationale Behind Use of a Filler
The basic idea behind the injection of hyaluronic acid (or other commercial fillers) is camouflage rather then correction. By filling in the cheek depression with a biochemical substance obtained from a syringe, a flatter contour can be achieved at the eyelid-cheek interface and the visual impact of the baggy eyelid thereby lessened.
• Does It Work? . . .