» blepharoplasty

What can I do for loose excess skin under my eyes after lower eyelid surgery a year ago?

Dr. Rivkin — Thu, 12 May 2011 18:09:17 +0000

I had consulted with a surgeon regarding loose sagging skin under my eyes which was not corrected after a procedure 5 years ago. He ended up doing pretty much the same procedure. I still have these loose skin pouches under my eyes. I read about a skin pinch and am very interested

Looking at your picture, I would say that your primary issue at this point is volume loss, not loose skin. The volume loss goes from the tear trough area under the eye and extends into the anterior cheek in a typical diagonal pattern. I see patients with this issue on a daily basis. Injecting Radiesse in the cheek area and Juvederm or Restylane in the tear trough corrects the volume loss and looks smooth and natural. The procedure is essentially painless (after numbing cream), takes 10 minutes and lasts for a year in the cheeks and 2 to 3 years in the tear troughs. Risks are limited to bruising and a bit of swelling. The nice thing about using hyaluronic acid (Juvederm or Restylane) is that these fillers are dissolvable at any time with a quick injection of an enzyme. So, even if there is some persistent swelling afterwards, it is entirely correctable.

I have bags and lines under my eyes- what really works to remove or help them?

Dr. Rivkin — Wed, 11 May 2011 18:38:14 +0000

There are multiple reasons why the skin under your eyes can appear baggy. It is hard to point you in the right direction without pictures.
You need to speak to a good specialist (and preferably more than one) who can advise you on all of your surgical and non surgical options. Improving the appearance of your eyes can be as simple as getting a few injections of Botox. It could be that you need a bit of filler (Restylane or Juvederm) in the tear trough area that fills in an area of volume loss and smooths the contour of the lower lid. Often this eliminates the appearance of puffy under eyes without surgery and the effect lasts for 2 to 4 years. Laser is also an option for some people who have fine lines throughout the lower lid. Lastly, surgery can give great results to the patients who are good candidates.

NON-SURGERY BLEPHAROPLASTY–IS LASER GOOD ?|FILLERS DO NOT LAST LONG ENOUGH ALSO DARK CIRCLE AND HOLLOWNESS WHAT WILL WORK??

Dr. Rivkin — Wed, 30 Mar 2011 18:47:56 +0000

Laser is good for fine lines, but not for hollowness under the eyes caused by volume loss. as we age, we lose fat and one of the first places is under the eyes. When a hollow forms, shadow falls into it and you get dark circles. The only solution to this is to fill it. my preference is a hyaluronic filler like juvederm or restylane, not fat. The reason is that these fillers can be dissolved, either partially or completely with an enzyme called hyaluronidase. I do not like fat for most people because it is a more invasive procedure (filler injection takes 10 minutes and i use topical anesthetic cream) and cannot be reversed. I would disagree that fillers do not last. hyaluronic acid under the eyes lasts for several years.

What is the best filler for under eye hollows

Dr. Rivkin — Mon, 10 Jan 2011 18:39:44 +0000

I prefer Juvederm to Restylane in the under eye hollows, but one can get good results from both. Different practitioners have their own preference for Restylane vs Juvederm. However, it should be one of those two. The reason is that HA fillers are reversible and the under eye area is unpredictable as far as how much swelling will take place after injection. Any bumps can be reversed with enzyme if an HA filler is used. There is no need to use anything else because HA (especially Juvederm) lasts for several years under the eyes. The most important factor in the success of the procedure is choosing an experienced and proficient injector. Always ask to see before and after photos.

I am honored to have been selected for the cover of this month’s MedEsthetics magazine!

Dr. Rivkin — Tue, 18 May 2010 17:02:37 +0000

First of all, it just goes to show that my mommy was right – I am special!

Actually, it is great to see the continued attention that non surgical facial sculpting is receiving.These procedures have been adoopted faster than I even expected back in the day (6 years ago) when it was all getting started.

Fillers and Botox have redefined the relationship that the average person has with the aesthetic field.

The last six years have seen a non surgical revolution and I look forward to all the new stuff we have yet to discover!

Under Eye / Cheek Filler

Dr. Rivkin — Fri, 27 Nov 2009 21:30:15 +0000

thank you for your quick reply, to my last question. you mention that the filler has to be injected deep for the eyes,,,in regard to malar cheek bag flattening, is there any risk to damage or blindness if done improperly, how deep should the plastic surgeon/dermitologist s have to inject, i have hollow eyes and the thought of these questions scares me. thanks again tg

experience matters!
injections of filler under the eyes can be technically tricky. although blindness is extraordinarily rare (i have never seen this, nor has any doctor i know seen it, but i have heard of a case being reported in the literature), it is theoretically possible. the filler should be placed deep against the bone by an injector who is very experienced in filler injections under the eyes.

New Press

Dr. Rivkin — Wed, 11 Nov 2009 20:58:20 +0000

There’s been some nice stories done recently about the stuff I’m doing.
It’s good to see that the word is getting out about these procedures.
Here’s some links:

New York Times

The Doctors TV show

MedEsthetics Magazine

About.com

Enjoy!

Non Surgical Blepharoplasty

Dr. Rivkin — Tue, 22 Sep 2009 23:58:08 +0000

I’m considering having filler injected in my under eye circles. I’ve had this done twice before. The first time I loved it (That was a little over a year ago). About a month ago I went to get a touch up from a new Dr. (I moved recently) and I hated the results. It looked like the whole area was just pushed up and not filled in. I also got a blueish hue. I had it dissolved with vitrase. The first doctor used a fine needle to do the injection, while the second used a blunt cannula. I wasn’t aware that there is a risk for blindness until I went to the second dr who said using a needle can increase risk for injecting into a blood vessel. This has me scared and uncertain as to what to do. My hollows really really bother me. The second dr. seemed to convey the chance of injecting into a vessel with a blunt were near impossible and that it was very safe through this technique. Yet I hated her results. I’m not sure if it had anything to do with the needle vs blunt or if her technique was just off. Now in doing research, I’m overwhelmed with information. I’m seeing different safety precautions that can be used. (Withdraw the needle to ensure not in a vessel, use blunt tip, use epinephrine) I’m also reading about different aesthetic techniques (under the muscle, above the muslce, multi-planar, Thread behind the needle, push the needle forward while injecting). I really don’t know what I should be looking for in a surgeon. And I absolutely do not want to have surgery. First and foremost i’m concerned about safety. Clearly I don’t want to trade my under eye circles for blindness. Yet I’m sick and tired of having people asking whats wrong- you like tired or sick. I’m looking for a dr. to tell me if there are techniques that eliminate the risk for blindness (if not eliminate, minimize)?

You need to find a doctor who is very experienced in this technique. experience matters more than philosophizing about theoretical dangers of blindness. i have injected filler (always hyaluronic acid and always using a regular, sharp needle) under the eyes of about 1200 patients and have never had a serious complication. i have not seen a single case of blindness from filler injection under the eye reported in the literature. the artery is so small and the risk so remote that sacrificing good results to prevent this unheard of complication seems silly. insist on seeing the doctor’s before and after pictures to evaluate their aesthetic sense and to make sure that they have done enough cases to show some good ones. if you’d like me to take a look at your pictures, i would be happy to.

Non Surgical Blepharoplasty – A Real Option For Dark Circles and Tired Eyes

Dr. Rivkin — Sun, 31 May 2009 21:20:00 +0000

Eyes that look tired have historically been difficult to treat. The reason is that the appearance of tired eyes is caused by several factors, some of which respond to treatment and some of which do not. There are usually four components that make up the appearance of puffy and tired looking eyes.

1. Dark pigmentation of the skin under the eyes. The predisposition to this is usually genetic. Some people get it early in life and some later. Pigmentation is also affected by ethnicity. Indians, for example, are more prone to having noticeably dark pigmentation under their eyes.

Treatment options: Not a lot that can be done about dark pigmentation. Bleaching creams with hydroquinone or kojic acid sometimes help.

2. Fine lines and wrinkles throughout the lower and upper lids – “crepey” skin. This comes to most people with age. Of course, there is some genetic variability as to when and how severe the wrinkles become. These fine lines are cause by the loss of elasticity and subcutaneous fat that comes with age. The other major factor that accelerates the development of these lines is sun damage.

Treatment option: Currently, the only solution to this issue is laser treatment. The only type of laser that I have seen that actually makes any difference in under eye wrinkles is the fractionated CO2 laser. Examples of this kind of laser include the Active Fx and the Fraxel re:pair. The laser treatment is relatively quick and easy, but there is about 7 days of downtime. Results are dramatic.

3. Bulging of the skin under the eyes caused by fat tissue that is “pooching” out. Again, this is a combination of age and genetic predisposition. This effect is caused by a weakening of the membrane that usually keeps orbital fat in check. The fat tissue bulges through the membrane and into the skin of the lower eyelid.

Treatment option: This is usually a surgical issue. If there is a large amount of bulging, only blepharoplasty with fat repositioning will really help. However, if there is only a small to moderate amount of bulge, the doctor can use hyaluronic acid (Juvederm or Restylane) under the bulge to camouflage the appearance. If you raise the skin under the bulge with a filler like Juvederm, filling in the valley between the cheek and the lower eyelid, the observer no longer sees the bulge.

4. “Tear trough” under eye area indentation – this is the situation that is most common in my practice. Age and genetic predisposition cause fat loss, leading to an indentation in the “naso-jugal groove” (the area underneath the lower eyelid, above the cheek), a shadow falls into the groove and the person’s eyes appear tired. This is easily corrected with injection of a hyaluronic acid filler. I prefer Juvederm because it is smooth and lasts for over 1.5 years in that area. This is a technically difficult procedure and should be done by experienced injectors only, so if you’re thinking of having this procedure done, you should certainly find out how many the doctor has performed.

Aside from filler there lasting 3 times as long as any other area, the other unique quality to the under-eye area is that it is pretty much painless. The skin doesn’t seem to have alot of pain nerve connections.

5. Loose upper eyelid tissue that overhangs the eyelid is another element in making the eyes look tired. This is exclusively a surgical issue. A conservative surgeon should be able to take off only a small amount of skin, leaving a natural appearance. The danger in being too aggressive is that the patient will have a hollow appearance to their upper eyelid area. Future fat loss with age should be taken account of and the surgeon should err on the conservative side. A good if slightly tight result now can become a hollow, terrible result in 15 years.

Juvederm or Restylane Under the Eyes

Dr. Rivkin — Tue, 12 May 2009 23:31:00 +0000

Dear Dr. Rivkin,

I have seen you televised on many reputable shows, and have also followed your threads on this website. Therefore, I have decided to pose this question to you instead of other doctors. (Thank you for all your great and candid posts!)

If I am considering an injectable for hollowing of the eye area, such as Restylane or Juvederm, is it reasonable for me to ask a doctor or nurse (injector) to first inject me in an unnoticeable area (such as my hand) to guage my body’s reaction to the material?

Because I have had eczema in the past, with much itching, I am concerned that I may have an allergic reaction to injectables. (Bumps are also a concern, as I have thin skin) I am thinking that this type of request would seem normal to doctors, but I have never read about anyone asking for a “test injection.”

hi emii,
you can certainly ask for a test injection and i’m sure any reputable doc or injector will do it. be sure to go to someone who has a bunch of experience with the procedure, preferably that you can see with before and after pictures. i have never seen any allergic reactions to restylane or juvederm, even with eczema patients, and i’ve probably done about 1000 eye patients.
also, the person you go to must have be comfortable working with hyaluronidase – the enzyme that dissolves the restylane or juvederm just in case you get a bump or a bit of over injection (it happens to the best injectors)
hope that helps