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Eyelid Rejuvenation: Fillers vs Surgery

Renata Khelemsky, MD, FAACS

The journey of aging gracefully often brings us to the crossroads of eyelid rejuvenation. Dr. Renata Khelemsky, a fellowship-trained and double board-certified New York City-based Facial Cosmetic Surgeon, invites us to explore the nuanced decision-making process between two popular options: dermal fillers and eyelid surgery.

Eyelid Rejuvenation model

Can Dermal Fillers Brighten the Eye Area?

Undereye rejuvenation is possible without surgery with the advent of in-office dermal filler treatments. Dr. Renata believes in the versatility of fillers for addressing undereye concerns such as dark circles and hollowness, even addressing hollow triangles of the upper eyelids. With age, the eyelids tend to lose their youthful fullness due to the depletion of natural anatomical fat. Also, prior surgery that removes fatty tissue around the eyelids can be overzealous and cause unwanted post-surgical hollowing.

Dermal fillers provide a relatively simple solution for volume loss. Using a conservative amount of fillers along the lower eyelids or even the upper eyelid crease can add what is missing, whether due to aging or prior surgery. The key is to remember that a little bit goes a long way. The amount of filler "required" is proportional to the amount of mid-face volume loss present. Some patients may need half of a syringe, while others may find that two syringes create a more satisfactory result.

I Have Heard that Under-Eye Filler Can Go Wrong … What Do I Need To Know?

While it is true that dermal filler procedures around the eye area carry the risk of bumps, lumps, and other irregularities, seeing a board-certified facial specialist greatly increases the success of this procedure. Knowledge of the delicate anatomy of the undereye and upper eyelid region is paramount to the placement of filler. Also, understanding which type of filler is ideal for this delicate and highly sensitive region is key to avoiding common side effects such as prolonged swelling, bluish discoloration (known as the "Tyndall Effect"), and surface irregularities.

Not all fillers are created equal, and some fillers are synthetic, inflammatory, and permanent, making them a poor choice for nonsurgical eyelid rejuvenation. Dr. Renata recommends using strictly hyaluronic-acid-based fillers around the eyes or near the eyes due to their compatible nature with our own connective tissues compared with other fillers made of acrylic, calcium, or lactic acid.

Am I A Candidate for Eyelid Rejuvenation Using Fillers?

Rejuvenating the undereye area through dermal filler treatment is a viable option for many patients. Dr. Renata, who specializes in rejuvenating eyelid surgeries, prioritizes a balanced approach between safety and cosmetic benefits.

Candidates suitable for undereye dermal filler typically exhibit the following clinical features:

  • Mild to moderate hollowness in the undereye area
  • Relatively youthful skin of the upper and lower eyelids
  • A shallow tear trough in the middle corner of the lower eyelid
  • Mild to moderate undereye bags

However, there are instances where dermal filler may be less effective, such as in cases involving:

  • Excess draping skin of the lower or upper eyelids
  • Severe puffy undereye bags
  • Purple or vascular discoloration of the under-eye bags
  • Significant sun damage in the eyelid area
  • Patients sensitive to eyelid swelling due to allergies or diet sensitivities

This nuanced evaluation underscores the importance of consultation. The best way to determine if you are a candidate for dermal filler eyelid rejuvenation is through an in-person assessment to ensure you receive recommendations that are specifically tailored to your needs.

Insights into Eyelid Surgery:When Is the Right Time?

Patients who are not suitable candidates for dermal filler may consider exploring surgical treatment options. Surgery is less about timing and more about a finding. The right time for any surgery is whether or not a patient exhibits the features that can be improved with a surgical approach. A patient in their thirties may exhibit the same features as someone in their fifties due to lifestyle habits or genetic predispositions. An advantage of consulting an experienced surgical provider is the ability to discuss both avenues in a single consultation, eliminating the need for separate discussions across multiple providers.

Individuals who notice "crowding" or heaviness in the upper eyelid region will learn that upper eyelid surgery, also known as upper eyelid blepharoplasty, is a straightforward and permanent solution. This surgical procedure effectively removes unwanted, crepey, and excess skin from the upper eyelid crease. The recovery period is also relatively short and simple – most patients return to work and social activities after approximately one week.

For patients who may not be eligible for dermal fillers in the lower eyelid area, a more intricate and comprehensive approach involves lower eyelid lifting or blepharoplasty. Dr. Renata's philosophy emphasizes the preservation, rather than removal, of eyelid fat. This approach is particularly beneficial for individuals with advanced lower eyelid aging, large bags, and excess tissue-paper skin. Lower eyelid surgery involves tightening, lifting, and reusing lower eyelid fat to achieve a smooth surface finish. Dr. Renata's strategy aims to avoid post-surgery hollowing by keeping the lower eyelid fat to create a natural, long-lasting, and permanent solution.

The Art of Professional Evaluation

Choosing between fillers and surgery involves a meticulous evaluation process. Dr. Renata emphasizes the need for a surgeon with an experienced eye, one who can assess every anatomical nuance – from the tightness of the skin to the elasticity of the eyelid ligaments. Often, patients enter a discussion regarding the interconnected dynamics with adjacent areas like the brows and cheeks to fully understand their unique aging process.

It is important to note that while patients may have relatives or friends who have had a positive experience with dermal fillers does not guarantee or suggest that they themselves will have a similar experience, even in the hands of the same provider! Anatomy, physiology, age, and your own tissue reactivity all play a vital role in the overall experience of healing. This level of professional scrutiny, Dr. Renata notes, is a vital step of the consultation process.

The Beauty of Millimeters

Embarking on the journey to eyelid rejuvenation, the choice between fillers and surgery becomes a personalized exploration. The eyelids, being our body's most delicate and thin-skin structures, undergo significant changes over decades of aging, impacting our daily appearance and sense of youth by mere millimeters. Dr. Renata underscores the importance of professional evaluation and the potential for a harmonious blend of treatments as an art. In the pursuit of timeless beauty, the true power of transformation lives in meticulous details.

To uncover your personalized path to eyelid rejuvenation, schedule a consultation with Dr. Renata Khelemsky, our distinguished board-certified Facial Cosmetic Surgeon, and explore transformative possibilities tailored to your unique needs.

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