Q. I had a lower bleph and now have hollowness around my eyes and am thinking of getting a bit of Restylane in the tear trough area by an experienced injector. I don’t, however, want to end up looking like one of these celebs. I suspect they all had lower blephs too (you realize this after you’ve had one) and am concerned they had filler that migrated over time but not sure. What other reason would cause the visible lines, lumps, and swelling in their faces in your opinion? Much appreciated!
A. The lure of a visible scar from a traditional lower lid blepharoplasty scares away many a patient. Many proceed to a trans-conjunctival blepharoplasty (TCB) which removes the fat bags but does nothing to rejuvenate the lower eyelid skin looseness, the tear trough nor any cheek descent.
These celebs have natural descent of the aging cheek with separation of the soft tissues and loss of cheek volume.
Options for this hollowness, as you describe include:
- filler in the deep medial and lateral fat compartments of the anterior cheek (ie the “apple” of the cheek, filler under the zygomaticus muscles to lift the nasolabial fold and cheek mound; all using a projecting hyaluronic acid (HA) filler such as Voluma or Lyft.
- further layered HA filler such as Juvederm Ultra Plus or Restylane in the more superficial subcutaneous layer under the orbicularis muscle and along the tear trough
- if you are a candidate and you did have a TCB, consider a modified traditional blepharoplasty (no more fat removal) with possible mid-face lift (to elevate the soft tissues of the cheek and close the tear trough separation) with muscle suspension or canthopexy.
