Drooping eyelids, dark circles, bags or sunkenness in the infraorbital area under the eyes can be a premature sign of aging, or make an individual look unhealthy or tired. Healthy and fit individuals with any one of these conditions may look unwell or dragging, even when they are not.
In 2009, 203,000 Americans underwent a blepharoplasty (eyelid) surgery.1 Blepharoplasty is the third most popular cosmetic surgical procedure in America. Still, the number of people undergoing this popular procedure is down nearly 20% from 2000 because of the liquid face lift alternative. For some individuals, blepharoplasty surgery might be the only solution. For others, specific dermal fillers and BOTOX®, precisely placed, with advanced liquid face lift injection techniques may be a less invasive alternative, often referred to as a Liquid Browlift or non-surgical Browlift.
In this section, we will discuss how physicians are using progressive medical techniques and advanced liquid face lift products, including dermal fillers such as Juvederm®, Radiesse® and Restylane®, as well as BOTOX® , to contour areas around the eyes, non surgically. With liquid face lift products, physicians can correct or diminish a number of problems, such as drooping eyelids, bags, appearance of dark circles or sunken areas under the eyes and in the tear trough.
Before dermal fillers are applied, most healthcare providers will numb the areas to be treated with a topical anesthetic, local anesthetic or nerve block, depending upon the area to be treated and physician’s preference. Also, ice is often used during and after the procedure to help control any swelling.
Note: Before undergoing any procedure discussed on this web site, make sure that your doctor has extensive experience with the specific procedure. Medical schools have only recently begun to teach some of these procedures. As with any medical procedure there are varying degrees of risk involved. Please consult your physician.
A physician who is experienced in advanced liquid face lift techniques may help lift a drooping or hooded eye lid with one or more of the following procedures.
One of the ways a medical practitioner will non-surgically lift the upper eye lids is to place an advanced dermal filler like Juvederm® or Restylane® immediately behind the eye brow, under the skin. This technique is a way to provide a gentle lift to a sagging eyelid. It also can serve as an appealing accent to the eyebrow line. An ancillary benefit of this procedure is that it can help lessen squinting, which decreases the tendency to develop crows feet (lines extending from the corners of the eyes).[See Eye Area Wrinkles section)
Another technique that is utilized is to place dermal fillers, such as Juvederm® or Sculptra®, in the temple area. This provides a gentle and subtle lift to the brows and eyes, as well as other parts of the face. It also can help produce a nice contouring of the forehead. In many individuals, the temples flatten with age making the forehead look a little gaunt. Liquid face lift products can restore a more natural contour to the forehead.
Yet another technique a few physicians are using is placement of liquid facelift products such as Sculptra® or Juvederm® in the forehead. The product is placed beneath the skin across the forehead. If Juvederm® is utilized, most physicians will gently massage the forehead to spread it uniformly. If injected properly, the dermal fillers are almost always not visible.
The forehead injection technique can also help if the individual is showing what are known as suture lines on the forehead. Suture lines are vertical creases in the forehead where plates of the skull grow together during infancy. The line is virtually invisible until the skin begins to thin with age.
In combination with the dermal fillers, BOTOX® is usually injected into specific muscles, and specific areas of the muscles, generally in depressor muscles between and on either side of the eyebrows. These injections effectively relax the muscles that are pulling down, letting the muscles that are pulling up win the battle between them.
The BOTOX® procedure helps extend the life of the dermal fillers . Muscle movement works to break down the dermal fillers over time, so with exaggerated muscle movement under control, the dermal fillers last longer. Regular BOTOX® treatments will extend the life of these dermal filler procedures.
The procedures mentioned above can also affect wrinkles, lines and crêping.
Advanced dermal fillers are placed above the periosteum (deeper than some other facial areas) from the cheek to the infraorbital rim (the bone below the eye socket). Radiesse® can be an effective filler in this area because it can provide the necessary bulk and then assists the body in building its own collagen for endurance. Bulking fillers such as Perlane® and Juvederm® Ultra Plus are also used widely by physicians for this procedure.
In most facial areas, dermal fillers are placed by physicians with what are known as threading or tunneling injection methods. Essentially these techniques place the dermal filler beneath the skin (depth depends upon specific filler and facial area) in tunnels that are roughly on a horizontal plane with the skin.
In the cheek area, some physicians prefer a coning or bolus technique with some of the dermal fillers. This method places the dermal filler perpendicular to the skin, placing it deep so that the cones of fillers push up on the dermis. As with the tunneling technique, the dermal fillers are not visible underneath the skin. The coning method is not usually used in individuals with extremely thin skin.
Sunken eyes and dark circles are treated much the same as bags are treated. The goal is to fill in the cheek and part of the deficit under the infraorbital rim, which can provide a shapelier contour and in many instances nearly eliminate the hollow, gaunt appearance.
Various theories are propounded about the cause of dark circles. Some literature points to vascular issues. Some say it is a light refraction issue caused by either bulging bags or sunken hollows. In any event, the dermal filler procedures mentioned in the section above will have some effect on dark circles below the eyes and in the tear trough. Some patients have reported astonishing results.
1Blepharoplasty Statistical Source: American Society of Plastic Surgeons
Paul Vitenas, Jr., M.D., F.A.C.S., Houston, TX
Mark Berkowitz M.D. , Sterling Heights, MI
Richard Fleming MD FACS, Beverly Hills, CA ~ Joseph A. Eviatar MD FACS, New York, NY
Amy Forman Taub M.D., Lincolnshire, IL ~ Jane J. Olson MD, Baton Rouge, LA
Deborah Hudak M.D., Raleigh, NC ~ Dean Kane, M.D., Baltimore, MD
Robert Gray MD, Pleasanton, CA ~ Jane J. Olson MD, Norwalk, CT