Eyelid Filler Injection

From EyeWiki


Introduction

This article reviews the indications and management for filler injections in the eyelids.

Indications for eyelid filler injection

The main indication for eyelid filler injection is for cosmetic reasons to add volume around the eyes, although it is also used for functional reasons (such as mechanically altering the eyelid to help close the eye better).

Eyelid filler is injected in hollow under eyes (tear trough area) to improve or eliminate dark circle, tired appearance. it can also be injected into hollow upper eyelid/brow area.

The hollowness around the eyes can be inherited but it is almost always worsened by continued fat loss around the eyes/face that occurs in the aging process. take this analogy: the face is like a balloon, except it is filled with fat instead of air; when air is taken out of a balloon, the balloon deflates with resultant saggy hollow tissue; the same can be said of the face except it is fat that is melting away with age. adding volume in these hollow areas around the eyes (and face) can help create more youthful, rested appearance with natural results.

Anatomy of eyelid/orbit

A thorough understanding of the eye/orbit is essential when evaluating patients for possible eyelid filler injection. Eyelid skin is thinnest skin in the body, therefore it is not as forgiving as other facial skin/structures. The relation of the orbit (eye socket) to the eyelid is also critical as it can influence the surrounding eyelid contour. Eyelid filler may need to be injected close or in the orbit to obtain the desired cosmetic result. Care should be taken to avoid the angular vessels medially when injecting the tear trough region. Likewise, the pretarsal eyelid should be avoided as the skin and subcutaneous tissue are extremely thin, causing lumpiness and Tyndall effects to be much more likely.

Diagnosis

Clinical examination of the eye, orbit, and surrounding structures is needed to determine the candidacy of the patient for eyelid filler injection. Relative hollow areas need to be examined.

Rarely, eyelid swelling or allergies or masses can create eyelid contour irregularity. These other etiologies need to be ruled out.

Signs/symptoms

Hollow under eyes (tear trough deformity) creates tired, older appearance to the eyes and face with classic under eye dark circles. The same phenomenon hold true for the upper eyelid/brow area. Adding volume (via eyelid filler injection) in these hollow areas can help create more youthful, rested appearance with natural results.

Types of Eyelid fillers

It should be stated that filler injection is considered off-label when injected around the eyes, however they have been used for many years with great safety record.

There are various filler materials available on the market. It is important to use safe, temporary, reversible filler types around the eyes. That includes the hyaluronic acid gel products and more specifically Belotero or Restylane as these two are the softest and retain least amount of fluid. Hyaluronic acid gel products are reversible using hyaluronidaze. These fillers, on average, last longer than one year around the eyes.

Technique

Eyelid filler is injected around the hollow areas around the eyes with the patient in a sitting position. Topical anesthesia can be placed but it is not usually necessary.

The filler is injected deep, usually on the orbital rim bone, in small amounts in retrograde fashion. The result is immediate and patient's input can be taken into account with a hand-held mirror. Usually, 1cc of filler in enough for lower eyelid hollows, tear troughs. The upper eyelid/brow may need more or less filler amount.

Post-procedure regimen

There is some bruising/swelling in the injected sites around the eyes, that last about a week. The recovery is painless and no restriction in physical or visual activity is needed. The effect of hyaluronic acid gel around the eyes is more than one year, on average. Additional filler can be injected in subsequent visits, but usually less would be needed.

Complications

  • Undercorrection
  • Overcorrection
  • Contour irregularity
  • Persistent swelling (Tyndall effect)
  • Extremely rare vascular occlusion

Additional resources