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.

Although it has yet to be proven that certain laser treatments can accelerate facial volume loss, anecdotal evidence shows that especially around delicate thin skin such as around the eyes and temples lasers might accelerate facial volume loss. It is normal to lose facial fat with the normal aging process so it would be hard to tell what is truly causing the facial volume lose or the loss of fat round your eyes. Unless there is a controlled trial where a laser was only used on one half of the face we might never know!

People with orbital fat loss or hollowing around the eyes usually state that their eyes actually look better when they wake up in the morning and they are puffy. As the day progressed they state that they eyes look worse and more tired and hollow.

It is possible to address this orbital volume loss and hollowness with injections of either fat or fillers.

Orbital fat loss is probably the most important contributor to the aging of our eyes. In some people it leads to hollowness while in others it leads to loss of support of the brow and upper eyelid with resultant sagging and drooping. Adding volume is the most effective and most natural way of making the eyes look much more youthful, while also adding support to the eyelids leading to better eyelid function. Some people with complaints of dry eyes actually can benefit from adding volume and hence support around the eyelids. This might improve their dry eye problems.

What is the best way of adding volume? Fat or fillers such as restylane? Both can be effective and can have similar results. I routinely use both so can speak of the pros and cons of each. Fat injections can work very well in the upper eyelids. It is a bit less effective and can have more issues in the lower eyelid with potential for lumps. In the upper eyelids there could also be lumps from it but it is less of an issue. Fat injections are not the most predictable way to add volume because of the variable of how much fat will actually "take" in each area. It is not uncommon that a touch up will need to be performed several months after the first procedure.

The advantage of using fillers include ease, short recovery times, and much higher predictability that fat injections around the eyes. It takes just a few minutes to perform and you are set to get back to life as soon as the procedure is over. There of course can be some swelling and occasional bruising from filler injections around the eyes, but it is usually significantly less than fat injections for orbital fat loss. Fillers, of course, are not permanent, or at least Restylane isn't. In my experience filler injections around the eyes last a long time, sometimes several years, especially in the upper eyelid.

Both fat injections and fillers are great ways to add volume and support around the eyes for orbital fat loss. During your consultation the specifics of each will be discussed.

To learn more about orbital fat loss and eyelid surgery please visit our Eyelid Surgery page.

By Gal Aharonov

Assessing the best treatment to elevate a patient's brows is one of the main questions I get asked. Who needs surgery and who will benefit more from non surgical treatments?

My first question is whether or not a patient likes his or her brows when they were younger. If you had nice full brows that were at a good position and now they've deflated and are lower, in my opinion a surgical brow lift will not make you look better.

If you have always had a low brow, even when you were a teenager then surgery might be the best option for you, unless you have had a deficient volume to your brows even at a young age.

I believe that brow lifting surgery has been overperformed by many surgeons. Plastic surgeons get trained to surgically elevate the brows and when they encounter a patient with a "brow problem" they automatically assume a brow lift is needed. When I first got out of my training I was the same way.

Now the first thing I do is evaluate the volume of the brow and decide if the brow will be raised by added volume. If someone is hollow with a deflated brow a surgical browlift will make them look like a deer in the headlights and will make their eyes rounder! I have made this mistake in the past and regularly now see patients who have had endoscopic browlifts with the same issue. Over the last several years I have performed fewer and fewer endoscopic browlifts because of this.

If you are a good candidate for a surgical browlift, there are a few different procedures that can be performed. The most popular and common is the endoscopic browlift. I reserve this for patients with a relatively low hairline. If your hairline is already too high this procedure can make your hairline higher!

For patients with a high hairline, a hairline browlift can be performed. You can read more about this in the browlift section of the website.

By Dr. Gal Aharonov

The skin around the eye is very thin. Injecting fillers such as restylane and juvederm around the eye needs to be done by someone with plenty of experience. When done properly, injections of these "collagen" type products can be very beautiful and natural looking, but when done incorrectly can cause the issues you mentioned your friend having.

Your friend's lumps and issues can be reversed and fixed using a dissolving agent to melt away the filler. If she would like, she can have the procedure redone properly to have a more natural result without any of these issues.