This is a question I have been asked many times, and seems to be a common concern in the general population. This concern stems from just a couple of cases that have been reported in the medical literature about blindness occurring after injection of filler around the eyes. This is something I have never seen in my own practice. Why could this have happened? Well, there are theories concerning the filler accidentally being injected right into a major vein that also connects to the eyeball. I do know that injection technique is extremely important especially around the eye. Sometimes I have been shocked by witnessing extremely poor injection technique by some physicians and nurses. Fillers are tools for technicians to use. Poor technique is truly the reason for the majority of complications. Some complications like bruising and swelling are sometimes inevitable and luck based. Lumps should rarely occur if injected well. Again, I have injected thousands of eyes and have yet to ever witness a major issue like blindness. Is it possible? Sure. But I would put the probability at an extremely low level in an experienced injector's hands.

It is possible to do a blepharoplasty (upper eyelid surgery) and at the same time add volume to the upper eyelids and brows. Natural aging consists of volume loss in the brow pad and upper eyelids. Sometimes there is also increased laxity or relatively too much skin which ideally would be trimmed away as well. Depending on the particular case, sometimes a blepharoplasty is needed, sometimes just filler, and sometimes a combination of the two.

With the hairline lowering surgery, or forehead reduction surgery, the eyebrows are NOT raised with my technique. I cannot speak for other surgeons who's techniques can raise the eyebrows, but with my technique there is NO chance of that happening. Some people actually would like higher brows. For them it is possible to combine a browlift with the forehead reduction at the same time. That is an additional procedure though.

This could vary from person to person and from issue to issue. There are different reasons to inject filler around the eye such as under eye bags, under eye hollowness, upper eyelid hollowness, and upper eyelid laxity and droopyness. Filler needs to be injected in different ways to correct each of these issues. That is why there is no standard way to inject filler that is applicable for every issue.

Different people will react to filler differently. Some might swell a large amount, some might not swell at all. Some will not bruise at all, some might have significant bruising. Sometimes it is just luck, other times people might have a propensity to swell or bruise.

It also takes filler a few weeks to soften up and feel more natural. In thicker skin areas this is not a noticeable issue, but around the eye the filler might be palpable and sometimes noticeable for a few weeks.

Injections around the eyes should be taken as seriously as surgery at times. True, a majority of people will look great almost immediately and not have any problems, but a small number of people will have significant swelling and bruising. Make sure you are mentally prepared to maybe be one of those people before deciding to have injections around your eyes. Just because your friend came to me and looked amazing the next day doesn't mean that you are guaranteed to have the same result.

It is very common to have a slowly developing asymmetry to certain parts of the face. The upper eyelid is a very common place to see asymmetries that were not present at a younger age. Patients always ask me why one side is aging faster or losing more volume than the other. A few theories might be that the left side of the face in our country is exposed to more sun while driving. I have had patients that had severe burns on one side of the face when they were younger which sped up the volume loss on that side.

The best way to deal with upper eyelid asymmetries due to volume loss is with filler. Filler is way more accurate than fat or anything else that is currently available. To correct an asymmetry of the upper eyelids usually only a small amount of filler is needed. This can usually be done with just one treatment, but occasionally a touch up might be needed once the swelling settles to get it as perfect as possible.

There sometimes is an asymmetry in the actual amount of upper eyelid skin. If this is the case filler can be used to make the creases appear more symmetric, but the eyes will never be entirely symmetrical unless the superfluous skin is removed surgically.

The biggest indicator of upper eyelid symmetry is the position of the crease, more so than actual volume or amount of skin. The amount of eyelid that is seen is the most critical element. Usually even if there is an asymmetry in the amount of eyelid skin, or even mild ptosis of the eyelid on one side, the eyes can be made to look more symmetrical by adjusting the amount of eyelid show.

To learn more about upper eyelid fillers you can visit our upper eyelid filler page.

In general I can give patients a very good idea of how much filler around the eyes they will need before starting. That is why a consultation is so important. I can give most patients a reasonable idea based on a good quality photograph. Determining how much volume will be needed also depends on your aesthetic goals for what you want your eyes to look like. Some patients desire a very full look while others would just like to fill in some of the hollowness around the eyes.

As a rough starting point, an average patient will need anywhere from 1/2 a cc to 1cc of filler in each upper eyelid. Same goes for the lower eyelid or under eye area. If there is a considerable degree of hollowness you might need as much as 2 cc in each upper eyelid or under eye. This will be discussed during your consultation.

To learn more about fillers around the eyes click here for the eyelid procedures page

Upper eyelid filler lasts longer than almost anywhere else on the face or body. Routinely I have patients for whom it has lasted for over 3-4 years. When it slowly dissipates it usually does so uniformly. This makes upper eyelid filler a really great value for improving one's appearance. You must remember that there will continue to be aging changes taking place over those few years as well, so to maintain the aesthetic result you might want to top off your upper eyelid filler treatment every so often.

A Y lift is a trademarked name for placing filler in the face to restore a more youthful facial shape and contour. The concept has been around for years, but the term "Y lift" was trademarked by a dentist in New York a few years ago. Basically filler is placed around the midface, eyes, and chin and jaw area to recreate the shape of the face when it was younger. The theory goes that a youthful face is shaped more like the letter Y and as we age we lose the lateral volume of the upper face which makes our faces seem more droopy. The only thing I find problematic about this is that it promotes a cookie cutter approach to facial fillers and volumization. I believe that for patients who naturally have very high cheek bones a Y lift will only make them appear more gaunt and older looking. A personalized approach is needed for every patient.

Patients need to take the time to do their research. The media loves catchy "new" procedures; it is easy for them to report on and it gets good ratings. Remember that just because something is on television does not make it the "best" thing out there, it just might mean someone has the "best" PR person out there. Sometimes a "new" procedure is just rebranding or trademarking a term for something that has been around for years. Plastic surgery is an investment. Just like with any other investment, the more informed you are about the process, options, and expected results, the smarter you will be and hopefully make the best investment decision.

Eyelid ptosis is when the actual eyelid is sitting lower and if low enough can actually block your field of vision. Eyelid pseudoptosis is when the eyelid position is normal but more of the upper eyelid tarsal plate is showing due to an asymmetry or volume loss in the upper eyelid brow fat pads. Eyelid ptosis and eyelid pseudoptosis are very different in regards to treatment and need to be diagnosed properly and treated accordingly.

There is a non surgical option for the treatment of mild eyelid ptosis. Botox or Dysport can be used in very small amounts on the upper eyelid to help it open up a bit. This can correct the eyelid ptosis for about 3-4 months.

Eyelid pseudoptosis can be corrected by addressing the volume deficit in the upper eyelid and brow. This can be done with fillers or fat injections to restore the lost volume.

The following before and after photos demonstrate patients with very mild ptosis and pseudoptosis combined. Filler was used in her upper eyelids to balance the eyelid show combined with Dysport in the upper eyelid. The first patient has the problem only on the left eye, while the second patient has it affecting both eyes.

Left upper eyelid ptosis and pseudoptosis treated with fillers and Dysport

Bilateral upper eyelid ptosis and pseudoptosis treated with fillers and Dysport

Some surgeons use an incision in front of the hairline in the temple region. This can sometimes leave a noticeable scar especially if your skin color is not very pale white. Sometimes this also distorts the shape of the hairline in the temple region. Even if the scar healed well it could still be noticeable in this region. This same kind of problem can arise after a temporal brow lift if the incision was not placed correctly.

A scar revision is not always the best solution to solve this problem. Because hair bearing scalp might have been excised during the surgery, the shape of the hairline might be distorted. There are several other options that can be used to address this problem.

The first and simplest is especially useful in patients who have a pale scar with darker skin. The color contrast between the scar and normal skin is a big contributor to it being noticeable. Permanent tattoo makeup can be used to place pigment into the scar and reduce the contrast with the skin.

The second option is to use hair grafting to reshape the hairline and to add hair in front of the scar. As the hair grows in the scar will be more hidden inside the hairline.