Restylane Injection to Lower Eyelid Tear Troughs to Reduce Dark Circles Chevy Chase Maryland

[wen7ken]

Dr. Naderi, thanks for your video. It is very interesting. As you inject along the rim of the lower orbit, how can you be sure you are not injecting into the ifraorbital foramen? Thanks

[DrNaderi]

@wen7ken

Good question. I know where the foramen typically is and avoid that area. If you ever get too close to it the patient will experience severe pain and will let you know and that is another way you will avoid injecting into the nerve.

[comets69]

I just had this done today and it's been 10 hours and I feel like my under eye muscles are sore. Is that coming to w sore in the area? I only have one small bruise on my left side.

[DrNaderi]

@comets69

Soreness for a few days can be normal but check with your own plastic surgeon to make sure everything is OK.

[bonmom]

Hi Dr. N - why do you do multiple injections rather than place the needle through one site, go to the corner of the eye, and inject as you draw back (like a field block)? Also, does the Restylene come mixed, or did you add lidocaine yourself? Is topical EMLA not enough? Thanks - Dr. M

[DrNaderi]

@bonmom

Good question. The Restylane which I use is Restylane-L which comes premixed with lidocaine. As far as the injection technique, small micro droplets of restylane or fat placed on top of the bone are much more accurate than filling while pulling back retrograde. I do occasionally use that technique for people with very deep folds but the serial micro injections allow precision and accuracy.

[aTypicalDayInTheLife]

I'm 15 and I have a very noticeable vein under the skin that runs from my right temple to the inner corner of my right eye. The vein dips under my eye (which gives the appearance of a bag). It's horrible! Would this procedure work for me? If so, how much does it cost??

[DrNaderi]

@aTypicalDayInTheLife

You would need the consent of your parents but if the issue is a vein then you would need to see an oculoplastic surgeon to see if excision or cautery or laser of the vein is the better approach. Filling around it may or may not help but most likely it would be a temporary fix and as a 15 year old a more permanent solution is best. Leaving it alone for now is even a better idea until you are a bit older and can decide more objectively.

[piccolovic]

Hi Dr, I'm thinking of getting this done. I'm 51 and have had dark circles under the eyes for a very long time.

Is Restylane the best way to go for this? I would also like to do the part that is near the inner eye near the nose bridge? Is that a good idea or not?

I have very dark areas around the whole eyes.Especially under the eyes.

btw do you have nay recommendations for a Dr in southern CA? Im really scared to do this but I want to get it done anyway.Thanks so much! Vicky

[DrNaderi]

@piccolovic Hi Vicky. I cannot tell you if this procedure is good for your eyes and your "dark circles" without seeing you because there are multiple causes for "dark circles" inlcuding such things as hyperpigmentation or skin discoloration. If you have tear troughs and hollowness then this procedure can help but it is a very advance technique and you should find an excellent plastic surgeon or dermatologist and not just any injector. There are plenty of great doctors in Southern California.

[lilmini2010]

nytimes.com/2008/11/20/fashion­/20skin.html before deciding to go to the doctor read this article. I wanted to do the same thing for my under eyes but after reading many bad stories about fillers i change my mind! Fillers are not approved by the FDA

[DrNaderi]

@lilmini2010

The fillers that I use and most ethical plastic surgeons use in the U.S. are FDA approved. The FDA has very specific indications. For example the filler may be approved for wrinkles of the smile lines by the FDA. However, off label uses of the same filler would include filling other wrinkles of the face. No filler is 100% safe but these injections are done millions of times a year with very little problems if done by skilled plastic or facial plastic surgeons.

[xOxKurdParstxOx]

I want to do that MYSELF on MYSELF!

[DrNaderi]

@xOxKurdParstxOx

NEVER EVER EVER do any such procedure on yourself! EVER! You should not mess with your face or your safety!

[BhagyaRami]

Hello, I want to know what happens to the filler after 1 year? does it remain in your body? I want to know where does it go? Also how much does this treatment cost ?

Thank you.

[DrNaderi]

@BhagyaRami

Hi. As soon as the product is injected, your body starts to isolate it, wall it off and "digest" it so from the very start your immune system cells begin to "clean it up and take it away." This process takes anywhere from 3-18 months and when we talk about longevity we are talking about average duration of "visible effect." The treatment depends on how many syringes of product you need. It could be $350 - $1200 or more.

[tanyabaconguis]

good thing that you mentioned that there will be minute bruises in a few days? yes you were just being honest cause i had seen who had been treated with that filler and there were buises. But some doctors who had the same video as yours but never mentioned the bruises...and that is hiding the reality...thanks anyways!

[DrNaderi]

@tanyabaconguis

Some surgeons do not point out side effects and potential complications in order not to scare patients so that they can get the patient to do the procedure. I like to prepare my patients for all of the possible worse-case-scenarios no matter how rare they may be. That way they are always pleasantly surprised if they dont bruise and not shocked if they do. When a needle is inserted into the skin, bruising should be expected.

[lilrollz]

Dr. naderi i have hollow upper eyelids..can I get injections there and how long would it last?

[DrNaderi]

@lilrollz

Hi. Yes Restylane can be used around the orbital rims whether it be the lower eyelid hollowness or upper eyelid or even the temple area, etc. I do prefer Juvederm for the upper eyelid area though. These are very advanced techniques of filler injection so please do not let just anyone inject you. I have seen people get injected in people's homes or in spas or in gyms by non cosmetic surgeons and its dangerous!

[tinalouiseking]

she has pretty skin

[Mark1Mach2]

Dr Naderi, I can understand the filling of tear trough part of the video but I do not understand how this will help with the dark circles. I suffer from both and would like a treatment to cure both of them and not just the troughs. Thanks for the video, it is encouraging.

[DrNaderi]

@Mark1Mach2

Great question! The fact is the term "dark circles" refers to several issues that can combine to create the appearance of a "dark circle" under the eyes. Tear trough depressions is one cause. Hyperpigmentation, thin transparent skin, and lower eyelid fat bags are some other causes. Each has to be addressed and sometimes only makeup improves the area but as a male, makeup is not a good option.

[GAMINDORE]

How lasfull are the results ???? Can you precise it in years ????

[DrNaderi]

@GAMINDORE

Restylane to the tear troughs for dark circles under eyes lasts up to a year or so.

[slimsxyblkwoman]

What are the long term affects of injecting foreign matter into the body??? I know that there has to be something that they aren't telling us.

[DrNaderi]

@slimsxyblkwoman

Depends on the material. Restylane is a hylaruronic acid (HA). HA is a naturally occuring substance in your body. However the fillers are synthetically created. Are they 100% safe. Probably not. But thousands of people die every year from taking Ibuprofen or Tylenol! Safety is relative. Long term studies don't come out till something has been out for decades. There is nothing "THEY" aren't telling you. "They" just dont have all the answers yet.

[syk123456]

Doctor, can it be used to cover up mild proptosis (genetic, not thyroid problem or any other disease)?

[DrNaderi]

@syk123456

If it is VERY mild, it may improve the cosmetic appearance. The issue with proptosis is that the eyeball (globe) is too forward.  The issue with tear troughs is that the bone around the eyeball is too weak.

[nastyslapper]

My previous two questions (and it seems that of a couple other posters) are generally inquiring as to the exact location of the injections. This might be best answered graphically, though I'm not sure how best to do so here. Maybe this image at "faceandeye.co.uk/images/treat­ment/bleph_fig1.gif" would be a good reference (unless Dr. Naderi has a better example on hand). It would be very instructive to see it represented in (or even described in reference to) such a diagram.

[DrNaderi]

@nastyslapper

This is a very advanced technique and not something that can be described on youtube. I certainly do not want you or anyone else to watch a video or see a diagram or read a 3 line explanation and then go ahead and perform this technically challenging procedure. If you are simply trying to gather information for yourself then I think the video and the explanations below should be plenty. The injections are on the bone surface but the bone location depends on the patient's eyes

[nastyslapper]

Does this injection pass through any muscle tissue (e.g., orbicularis oculi)?

Similarly, do you inject beneath or above the muscle tissue? (I have read other accounts that Restylane should be injected just beneath the skin surface – which implies above the muscle tissue.) And are there situations where the injections should be made above or below the muscle tissue?

[DrNaderi]

@nastyslapper

As I have mentioned before, the injection drops are placed directly on the bone surface therefore the injections are deep to the skin, muscle and fat. 

[nastyslapper]

You mention that “it is crucial to be right over the bone in the tear troughs otherwise you will see lumps”. By “over the bone”, do you mean over the bone vertically toward the eye (as in, just above the ridge of the eye socket and just below the eye), or “right over” the bone distance-wise; as in, directly on top of the bone surface (but well beneath the eye socket)?

[DrNaderi]

@nastyslapper

The tear trough injection of fillers or fat injections may be placed in various areas but always on top of the bone surface.

[fidelcastro711]

Please tell me, are you injecting into the tear trough, the depressed part, or UNDER the tear trough? For some reason I see some injected under the tear trough which just creates a higher "wall" and makes the tear trough, next to this now rasied area, look even deeper. I cant tell from any of these videos where the dr is injecting. Please let me know. thank you

[DrNaderi]

@fidelcastro711

The tear trough is the depressed area and that is where the injections are. Injecting anywhere else would make the depressed tear trough look even deeper.

[madznation]

I'm 14 and I have it really bad. Its depressing & I cant stop obsessing about how ugly it makes me. they look way worse in the dark,.. when the shadows are on them. My mom has them too. I can't live with them. any tips on how to get my face to lift up .. its droopy I look 80! facial workouts dont work. I'm 5'6 & 130 pounds... Im not fat, Im skinny. I just wanna look like eevryone else my age; pretty. is 14 to young for a filler?

[DrNaderi]

@madznation

The physical issue may be correctable with cosmetic surgery. But the psychological issue which is arising as a result of the physical issue needs to be addressed too. There are plenty of 14 year olds with major deformities who are very happy kids. You should talk to your parents and see a plastic surgeon as well as a therapist in order to address both sides of the unhappiness. A simple injection like this may help you but proper guidance may alleviate the obsession as well.

[madznation]

@DrNaderi Thank you :) I'm getting psychologist, I'll just have to get over it .

[DrNaderi]

@madznation

My pleasure. As a 14 year old you need to be happy and concentrate on school and your future rather than your looks. Good luck

[madznation]

@DrNaderi I just wanted to let you know that I never had my under eye hollows a few months ago, they have gotten deeper and darker... Whould it have anything to do with weight gain? They are so much DEEPER and rounder then the lady in this video. Mine are very round and form a half circle under my eye .. she didn't even need to get this done. I still have baby fat do you thing it will go away?

[DrNaderi]

@madznation

Hi I would have to see you or your photos to be able to tell you what your particular issue is but I have seen and injected patient with MUCH deeper hollows than this patient.

[librequito]

hyaluronic acid

[ALiya131]

Dr.Naderi how long the bruising will stay under my eye..!!?

plz answer me :(

[DrNaderi]

@ALiya131

Without seeing you I do not know what you had done and how badly its bruised but typically bruises can linger for 1-3 weeks. Bruises do lighten up over time and makeup can help.

[ALiya131]

@DrNaderi

thanx Dr. but I didn't do it yet I'm afraid to do it I'm thinking will it hurt or the bruises will stay long!! that's why I'm asking u..

:) thanx 4 ur time..

[4eab]

Dr. Naderi-thank you for this informative video. I had Restylane injections for the tear trough but have had discoloration now for about 1 year afterwards. My dr said that my skin is thin and this bruise is just blood vessels under the skin showing through. My husband says I look like I was 'beat up'. I want to get injections again but do you think it will just make matters worse?

[DrNaderi]

@4eab

My pleasure. I cannot comment on your particular eyes without seeing you in person. However, some people have inherently thin skin which allows you to see the color of the muscle and blood vessels underneath. Others can have post inflammatory hyperpigmentation after the injection. Some patients get a Tyndall Effect and discoloration due to too much injection or too superficial injections or simply due to their very thin skin. See several good plastic surgeons and see what they say

[carmendiva25]

Congrats for the best video I've seen on the subject! You obvoiusly use the same technique which is probably safer in this area as you are less likely to damage the blood vessels than if you move the needle along although it did happen to you right at the end;-) Do you prefer Restylane most people advise Perlane in this area because due to its particle size tends to stay put and is better in the supraperiosteal area. Apparently it can last up to 18/24 months due to the immobility of the area.

[DrNaderi]

@carmendiva25

Thank you. Any technique can result in bruising and swelling because after all its a needle going through an area full of small hidden blood vessels. It is crucial to be right over the bone in the tear troughs otherwise you will see lumps. I like Restylane because it has a higher "G-prime" characteristic compared to Juvederm but it is not as bulky as Perlane. Any filler lasts longer under the eyes compared to the lips probably due to the immobility, etc.

[celia998]

I had an injection and my under eyes got bruise.Is it norrmal even for doctors with great skills?

[DrNaderi]

@celia998

Yes bruising is normal because even the most skillful doctor cannot see through the skin to avoid all of the blood vessels. But a skillful doctor will be more precise and cause less trauma.

[cbrf3redline]

can you remember if these took an entire syringe? i did not hear you mention how much was used. also, i wondered if you ever inject under the eyes closer to the malar area?

[DrNaderi]

@cbrf3redline

I did use the whole syringe. She actually could have used a bit more. Other patients may need only a small portion of a syringe. I do often inject the malar, submalar, midface, cheeks, zygomatic arch as well as the tear troughs. It just depends on the patient's needs.

[cbrf3redline]

@DrNaderi wow. wish i lived closer because i'd really like to try this.. but i'm in CT. have really been trying hard to find docs that are comfortable doing this. i've talked to several, and the response i've gotten is that they don't like to do it, or it's considered an "off label" use. one other question, what would your honest feeling be about the rate of retention for this - many people say it does not last long at all. what's your experience been?

[DrNaderi]

@cbrf3redline

It is off label according to the FDA but so is Botox to the forehead or Botox to the crows feet. Certail off label uses are widespread and acceptable amongst Board Certified Surgeons. Restylane to the tear troughs lasts about a year while the same Restylane to the lips lasts 4-6 months. This is an advanced technique and most doctors will not feel comfortable with it. As with anything, there are risks and you need to be careful.

[greyhoundNY]

thks so much sir.. merry xmas.:-))

[DrNaderi]

@greyhoundNY

My pleasure and Merry Christmas to you as well.

[greyhoundNY]

sir is this safe for me like if ever ill get this treatment, what will happen to the tear trough if i wont have a second treatment after 1 year or so, will it be the same b4 the procedure or will it get worse and i need to have the procedure again and again? pls answer gracias....!

[DrNaderi]

@greyhoundNY

I cannot tell you if this is safe for you since I have not seen or examined you. But if you are a candidate for this and you get the tear trough injection for dark circles by a skilled plastic surgeon and it goes well and then decide not to do it anymore, it should go back to the way it was before, more or less. But I have seen patients who had bad injections that caused swelling for several years or even scar tissue. You have to do your homework and research and be cautious.

[greyhoundNY]

OMG i want this so badly...I had tear trough ever since i was born got this from my mother..im 25 but i look younger than my age im afraid that when i get 30 or so it might have an adverse effect on my under eye..so for nw im just using this loreal eye cream...

[DrNaderi]

@greyhoundNY

Eye creams and general skin care is always a good idea but do not waste too much money on empty promises on TV and Radio ads claiming creams can get rid of "dark circles." The only way a cream will get rid of dark circles under the eyes is if there is hyperpigmentation and the cream can lighten the pigment. But also be cautious as this is a very advanced injection technique and not to be tried in a spa.