The impressive technological advancement concerning adaptability and its interaction with human tissues have made hyaluronic acid fillers quite popular over the last decade. Not only are fillers readily accessible to physicians, but they are also an excellent option for patients looking for a quick way to improve a facial feature that does not require a long recovery time or a trip to the operating room. Fillers can be applied in the doctor’s office in minutes, and patients may immediately appreciate the results.
But are fillers safe around the eyes?
As an oculofacial plastic surgeon, I have used dermal fillers from various companies with different compositions for years. I’ve had many happy patients, but I’ve also seen the undesired side effects of fillers. These side effects are especially noticeable around the eyes, where the skin is thin, and the room for error is virtually non-existent.
Nodule formation from a dermal filler requiring surgical excision.
In some cases, patients have come to my office dissatisfied with a filler and presenting a common complaint: a bluish hue that appeared under the eyes on the site of injection called the Tyndall effect. Although the enzyme hyaluronidase can be used to dissolve the filler, it is not always possible to remove this discoloration.
Bluish discoloration of the eyelid skin called Tyndall effect.
Another especially bothersome complaint, as I have yet to see it resolve satisfactorily, is a chronic swelling of the eyelid and cheek areas that persists despite time, massage, or any other type of treatment. This lymphedema, as it is called, is caused by damage to or blockage of the delicate lymphatic vessels of the lower eyelid region.
Fluid accumulation in the eyelid and cheek region.
These complaints have led me to investigate better options for volume restoration in the eye area. Fortunately, during a workshop at the University of Saint Louis School of Medicine, I had the opportunity to discuss these issues with other oculoplastic surgeons. To my great surprise, most of them had either stopped applying fillers under the eyes or were trying other options. This meeting was a turning point in my practice.
I have stopped applying dermal fillers around the eyes for the last several years. To treat bags under the eyes, I only offer my patients surgical options because I am convinced that, although it does require time off work, my patients will be pleased with their appearance for years to come. I firmly believe that facial fat transfer and blepharoplasty with fat transposition are the best options for offering my patients the most natural and elegant results without the complications of fillers.
Although I occasionally apply fillers for cheek and lip augmentation, my practice has veered towards facial fat transfer for volumetric rejuvenation. In summary, I don’t believe fillers’ relative advantages as a “quick fix” justify the risks associated with their application. Therefore, I have found much better therapeutic options to improve a tired appearance produced by bags and dark circles under the eyes.
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