Q: Dr. Eppley, I need help in figuring out the best way to enhance facial volume. I have hollowing under my eyes and would like a stronger jawline. I had cheek implants placed two years which have done great so am looking for similar impact on my other facial areas. But I’m not sure what the best way to accomplish this is using either facial implants, fat injections or injectable fillers.
A: When it comes to facial volume enhancement the surgical debate is always whether it should be done by fat injections or facial mplants. This is no different that the debate would have been about your previous cheek augmentation. There are advantages and disadvantages for either approach but that debate must be assessed more specifically for the facial area that one wants to enhance and whether it is composed of underlying bone, soft tissue or both.
The jawline is primarily supported by bone so any effective augmentation is almost always done by some form of implant placement. You would have to further define what jawline area to which you want changed to better answer what type of implant may best address it. This is identical to your cheeks which are usually most effectively done by implant because they are a bony supported area.
The under eye area is different than the jawline because it is a combined bone and soft tissue area. The lower end of the under eye area is the inferior orbital rim while most of the lower eyelid is soft tissue supported. This usually means that fat injections are needed as an implant only covers the very lower end of the under eye area and placing it requires a lower eyelid incision to do so. So fat injections, even though they are unpredictable, usually win out over any implant augmentation. Their ‘softness’ is kore appropriate for the under eye area than the jawline.
Dr. Barry Eppley
Q: Dr. Eppley, I’d like to inquire about getting injectable fillers under my eyes. What product do you use, what are the risks and what does it cost? What is the general satisfaction with patients having this procedure. I am excited about having it done but also nervous since it is around the eyes.
A: Under eye hollows, tear troughs and malar creases are becoming a popular treatment site for injectable fillers. When done well they can provide significant visual improvement of problems areas that previously were only treatable by surgery. For under the eye hollows, I generally use Juvederm placed with a microcannula technique. This usually eliminates any risk of bruising. The biggest concern in injecting under the eyes is that it is not overdone and that it is as smooth as possible. This means that it is injected down at the bone level along the infraorbital rim Of all the facial areas to treat with injectable fillers, this requires the most careful and skilled technique and a comfort zone with the surrounding orbital anatomy. The biggest risk is lumpiness or unevenness of the lower eyelids. The cost of treatment, which will usually last a year or more is around $550.