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admin | Natural Treatment Bacterial Vag | 01.10.2014
Procedure performed: Restylane hyaluronic acid fillers to lower lids and Botox to crows feet.
Preoperative Diagnosis: Lower lid fat prolapse, hollowing along her infraorbital rim, midface volume loss. Procedure performed: Hyaluronic acid filler injections to the infraorbital rim and midface. Procedure performed:  Injectablehyaluronic acid fillers (Restylane and Juvederm) to eyelid and cheeks. This patient wished to augment her loss of volume in her cheek area and her lower lids.   She underwent injectable fillers (hyaluronic acid) consisting of Restylane and Juvederm to help augment her volume loss in her eyelid and cheek area. Procedure performed: Injectablehyaluronic acid fillers (Restylane and Juvederm) to her eyelid and cheeks.
This patient desired an improvement in her lower lid dark circles.   She has loss of volume in her lower lid (lower lid hollowing) and cheek area, both of which are resulting in her dark circles. 2)      injectable hyaluronic acid fillers (Restylane and Juvederm) to the eyelid and cheeks. Note the overall improvement in her appearance with these procedures; all of which did not require her to undergo surgery. Procedure performed:  Skin whitening regiment, injectable hyaluronic acid fillers (Restylane and Juvederm)to the eyelid and cheeks, and TCA 30% peel to lower eyelids.
This patient wished to have her lower lid aging changes improved.  She had hollowed out lower lids, which were resulting in a tired look and early “dark circle” appearance. Procedure performed: Injectable hyaluronic acid fillers (Restylane and Juvederm)to the eyelid and cheeks.
This patient wished to have his lower lid bags improved.  He had early hollowing in his lower eyelid-cheek area.
Procedure performed: Hyaluronic acid filler injections to the infraorbital rim (aka tear trough) and midface.
Preoperative diagnosis: Lower eyelid bags (ie lowereyelid fat prolapse, right worse than left).
Procedure performed: Hyaluronic acid (HA) fillers to the orbital rim (tear trough) and midface. Side profile demonstrate the improvement in the eyelid bags, tear trough deformity (orbital rim hollowing), and midface volume. Preoperative diagnosis: Tear trough deformity (orbital rim hollowing) and loss of midface volume. Procedure performed: Hyaluronic acid (HA) fillers to orbital rim (tear trough) and midface. Preoperative diagnosis: Tear trough deformity (orbital rim hollowying) and loss of midface volume.
Procedure performed:  Restylane (hyaluronic acid) injections to her lower lids (infraorbital rim area and tear trough). This patient underwent eyelid fillers to her lower lid to help improve her appearance.  Hyaluronic injectable fillers to her eyelids were used.
This patient had lower eyelid and cheek volume loss and desired injectable filler treatment. She had undergone prior lower lid blepharoplasty with excessive removal of fat.  As a result, she had a hollowing result after surgery.
Procedure performed:  Injectablefillers (Restylane, Juvederm, Radiesse) to eyelid and cheeks. Procedure performed:  Injectablehyaluronic acid fillers (Restylane and Juvederm) to her eyelid and cheeks.
Preoperative diagnosis: Facial wrinkles, lower lid rhytids (wrinkles) and tear trough hollows (ie dark circles). Procedure performed: Botox to forehead and crows feet, hyaluronic acid (HA) fillers to the tear trough area and midface, 30% trichloroacetic acid (TCA) chemical peel to lower lids. Preoperative diagnosis: Lower lid fat prolapse (ie bags under eyes) and loss of midface volume. This photograph in the upper right was taken 1 month after undergoing hyaluronic acid injection using Restylane to the lower eyelids. Lateral canthoplasty may be considered as one of the most valuable oculoplastic surgical procedures to correct lid abnormalities. In this column, Swapna Vemuri, MD, and Jeremiah Tao, MD, FACS, describe their technique for lateral canthoplasty.

Lateral canthoplasty is a core oculoplastic procedure that treats an array of lower eyelid malposition conditions such as ectropion and retraction. In brief, the lateral canthal angle is deconstructed, and the lateral eyelid is re-anchored to the periosteum of the lateral orbital rim.
The tear trough, also known as the nasojugal groove, is a small lesion of skin that runs from the inner eye to the outer corner. Until recently, surgery used to be the only method for correcting tear trough deformity or under-eye bags, but Dr. Facial fillers are the primary treatment for the lower eyelids, which can certainly help in improving the volume deficiency or deformity people get with aging and can reduce the amount of herniated fat visible to others. The blunt-tipped cannulas used for my facial filler injections are similar to the ones used in the operating room for my fat grafting procedure, which has made the transition to using the cannulas in the office readily available. The patient shown above had dark circles that were present in both lower eyelids and the right eyelid was significantly worse than the left eyelid. She received dermal fillers to the eyelid and cheek areas to build up the volume she had lost due to aging. Oculoplastic surgery is a passion of ours and we are pleased to restore the youthful look of a patient’s face without the use of invasive surgery. When can I resume my activities and what are general post care instructions for my non-surgical cosmetic procedures? Preoperative diagnosis: Lower eyelid bags (ie lower eyelid fat prolapse, right worse than left). A customized approach of using botox around the crows feet and Restylane hyaluronic acid fillers were used. She underwent injectable fillers (hyaluronic acid) consisting of Restylane and Juvederm to help augment her volume loss in her eyelid and cheek area.  Note the natural-looking improvement in her appearance. She was unhappy about the dark circles and the excess wrinkles.  Her skin was hyperpigmented, which can by itself cause the appearance of dark circles. This was making his “bag” or lower eyelid fat pocket more visible.  Hyaluronic acid filler injectables were placed along the lower infraorbital rim area (aka tear trough area) and his midface to help restore the volume loss.
The dark lower lid circles are a result of a loss of volume in the tear trough area and a result of some “extra” fat that has herniated. She has lower lid aging which include prominent orbital fat and loss of volume along her infraorbital rim.
Voluma and Restylane (bothhyaluronic acid fillers) were used to augment her eyelid hollows and cheek volume loss.  Note the natural looking result noted after injectable filler treatment.
She underwent lower lid filler treatment using hyaluronic acid gel (Restylane and Juvederm). She has mild lower lid fat prolapse, thin eyelid skin along with minimal hyperpigmentation.
She had a successful result in reducing the amount of fat prolapse in her lower eyelids and reduction in the hyperpigmentation as well. Going past the cosmesis, eyelids have a functional role and, as such, indirectly become an integral part of the underlying globe. The indications include ectropion, entropion, lateral canthal dystopia, horizontal lid laxity, lid margin eversion, lid retraction with or without soft tissue deficiency, paralytic lagophthalmos and aesthetic improvement. The eyelid tightening effect also makes canthoplasty an important adjunct in many cosmetic lower eyelid procedures. Whether a part of a cosmetic or a functional procedure, a secure and well-positioned lateral canthus allows the eyelids to look and function normally.
A thorough preoperative clinical assessment delineates the vectors acting on the lower eyelid.
When these findings are present, horizontal eyelid shortening and re-anchoring may be beneficial; however, there are cases in which these techniques alone would be inadequate. If only a lateral canthoplasty and canthopexy are performed in an individual with a prominent globe, the lid slips under the globe.
The two-finger test in which one finger simulates lateral canthal fixation (a) and the second elevates the central lower eyelid (b), indicating the need for additional vertical eyelid support. At times when a patient is seen with a baggy or puffy palpebromalar groove it create a division of skin between the lower eyelid and cheek. They can often occur together and are both associated with either loss of fat or a gain in fat in certain areas around the eyelid structures. Zoumalan uses advanced techniques and injection treatments — with or without surgery — to rejuvenate this area of the face and to restore a more youthful, natural-looking appearance.

Some people end up having dark circles and others end up having more prominent bags appear in their lower lids as they age. Under-eye bags occur with age as the naturally occurring fat pockets around the eyeball grow.
I see them in patients as early as their 20s and also in mature adults, even up to their 70s and 80s. Fillers can also help improve the appearance of hyperpigmentation that is often present in such cases.
Zoumalan has introduced the use of a blunt-tipped cannula for most of the facial filler injections, which allows him to reduce the incidence of bruising and discomfort by a significant percentage in my patients. The green dots in the third image indicate the ONLY location that the skin was pierced to perform the procedure using a blunt-tipped cannula. The blue dots indicate where Restylane was injected (over the orbital rim) and the red dots indicate where Juvederm was injected (over the midface and cheek area). If you find that your eyelids are lacking ideal volume and in need of tear trough correction then fill out our consultation form to get in touch with Dr. Injectable hyaluronic acid fillers using Restylane and Juvederm were used to build up the volume around the eyelid and cheeks. The dark shadows are a result of a loss of volume in the tear trough and also a result of “extra” fat that has herniated.
Hyaluronic acid fillers were carefully injected along his lower lid and cheek area to improve his volume.  One can really see the improvement especially when the patient looks in upgaze (which accentuates his volume loss). Note the improvement in her lower eyelid hollows and her cheeks after receiving injectable fillers.
The 3D image is processed as a 3D video as well for accurate viewing in all angles and facial profiles. This procedure is a valuable adjunct to lower blepharoplasty, in the delivery of orbital tumors and in the prevention of some of the above-mentioned entities.
With time, the fat under the eyeball tends to protrude or herniate through the thin eyelid skin. The results are overwhelmingly incredible and the patients are extremely comfortable during the procedure with just the use of a topical anesthetic.
Injectable fillers composed of hyaluronic acid were used to augment her lower lids without having to undergo surgery. This allows for an improvement in the eyelid appearance and to better “camouflage” the fat pads. In addition, they play a significant role in the overall health of the ocular surface and are responsible for spreading the tear film from the lower eyelid tear meniscus to the entire ocular surface, hence contributing to optimal vision.
A second is a patient with midface ptosis or cicatricial (scar) disease in whom vertical vectors will likely overcome the single lateral suture anchoring. Christopher Zoumalan, MD FACS can treat patients for such conditions with tear trough fillers. People commonly complain of a tired look and note they have eyelid bags, puffy eyes, and under-eye bags.
Tear trough fillers have been performed routinely at our practice to provide natural and exceptional results. Although her “bags” are still present, they are much improved and she is very happy with her results. The procedure was done in two settings where a second visit was required for touch-up augmentation. Any compromise to the normal function and anatomic resting position of the eyelids can have a deleterious effect on overall facial cosmesis and potentially cause tissue degradation, including corneal epithelial breakdown, corneal melt and perforation. The whole procedure took 20 minutes and the patient tolerated it with no discomfort and bruising. If a second finger is necessary to further correct malposition of the central lid (Figure 3), then lateral canthoplasty alone may be insufficient.
Additional procedures may include implants, spacer grafts, midface advancement or a combination of these, which is beyond the scope of this article. Lastly, it is critical to evaluate for facial nerve paresis because these patients often need additional procedures to treat eyelid malposition.

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