What can you do to Improve the Under Eye Area (Tear Troughs)?

The area under the eyes suffers a double-whammy when it comes to aging. This skin is the thinnest in the body, so as the dermis thins out, the first place you notice it is under the eyes. Often we notice in our 30’s and think “wow I look like I’m really tired.” On top of that, as we age we lose the little fat pads in our face that make us look so round and youthful as kids– and the first one to go is that fat pad under the eyes. The result can be an angled divot under the eye covered with wrinkly skin, long before the rest of the face shows signs of aging.

So what can you do about it? That’s the number one question that brings people into our office. After years of experience, we have put together the treatments that work best. Here I’m giving you the low-down on these common treatments:

Filler

For volume lost in this area, filling it back up with hyaluronic filler can be a dramatic improvement. When you see that depression or divot, not only do you see a hollow with a shadow across it, but the overlying skin has less volume to cover and thus looks more wrinkly. We use a cannula technique to gently fill the volume lost. The effect is immediate. There is always some swelling with fillers that lasts a few days, but less with this area than others.

PRFM (Platelet-Rich Fibrin Matrix)

Many people have heard of PRP (Platelet-Rich Plasma). This is serum derived from your own blood, rich in growth factors. It has been used in orthopedics for decades, and we have been using it for facial rejuvenation and hair growth for about 6 years at Glow. PRFM is activated PRP, same growth factors but the platelets are activated with calcium. When injected, it forms a gel that concentrates the factors in one place. PRFM has been used to build up the natural tissues in the under eye area as well as elsewhere in the face. We use a similar cannula technique to place the PRFM in this area. Several treatments are needed, and the results happen over several months.

Laser Resurfacing

Fractional non-ablative lasers can resurface the skin to make it smoother. In addition, the laser heats up the skin, triggering it to make its own collagen. The laser also lifts pigment in the skin to help get rid of dark circles. Laser resurfacing can be a key part of treating the under-eye area because it is important to build collagen in the skin and smooth out the fine lines and wrinkles. Treating the volume loss alone is just half the battle. The laser treatments help address the skin itself.

Eye creams and serums

The skin under the eyes is special because it is so thin to start with and is in a very sensitive area. The skin here often needs more moisture than other skin in your body, and sometimes even develops pigment that isn’t present elsewhere. We offer several eye topicals that have different anti-aging ingredients. Adding eye creams to your regimen will provide antioxidants and ceramides to protect the skin and ingredients to plump the skin, trigger collagen and decrease dark circles.

What does Off-Label mean?

As with many aesthetic procedures, the use of filler and PRFM for the tear trough area is off-label. What does off-label mean? It means that the FDA has approved the product or treatment for some other indication. Then doctors develop new treatments with an FDA-approved product. For example– a certain filler is FDA-approved for placement in the cheeks and it is then used to fill hollows elsewhere in the face. Once these new treatments are developed and in use, rarely does the company that makes the product pay for studies to get official approval for an already FDA-approved product. Thus there are many products and procedures in use by doctors that are “Off-label.”

What is the best sequence of treatments for the under-eye area?

At Glow Medispa, we have been working on developing an under-eye package that includes all of these treatments. This new package includes a filler treatment, two PRFM and LaseMD Ultra treatments and our favorite eye serum from Sente. As with everything that we do, we customize treatments to meet the specific needs of each patient.

Think you might be a great candidate? Call us or come in for a consultation if you think you might be interested.

Every injector has her/his own preferences for what filler to use and for what purpose, and there are some very important considerations. All fillers are different in both texture and use. Some fillers, like Restylane® Lyft and JUVÉDERM VOLUMA®, are fairly stiff and firm. Some, like Restylane Silk, are very soft and silky. Yet others, like Restylane® Refyne and Defyne, have been designed to be flexible, to allow the face more natural movement.

For example, many women want fuller, plumper lips. I can tell you that I’ve seen just about every filler placed in the lips. But in my opinion lips should be soft and smooth and silky, like… lips. My favorite filler for the lips is Restylane® Silk. It gives great volume, but remains soft and smooth and is rarely lumpy. This is in contrast to JUVÉDERM® Ultra Plus and Restylane® L, both of which are mainstays for lips. However, those tend to be too stiff and lumpy. Almost everyone who has had JUVÉDERM® in their lips will say they’ve had a lump before. The lumps are not visible to others,  but you can feel them with your tongue. I’d prefer to skip the lumps. Another filler I like for lips is Refyne, because it is also very soft, flexible and it does not swell up as much as other fillers do, but is not quite as volumizing as Silk.

For cheeks, I like JUVÉDERM VOLUMA® and Restylane® Lyft. These fillers are firm and are placed along the cheek bones to give volume to the cheeks. You need strength and firmness to fill out the cheeks, and because the placement is deep, issues with lumpiness are rare. You would never want to place a soft filler in the cheeks– it would not have enough substance to hold the tissues up. It would just melt away and be a waste of money.

The area under the eyes (the tear troughs) are very delicate.  A soft filler is best: one that won’t be lumpy (similar to the lips) and  one that won’t press on any of the nerves or vessels in this area. Ideally, tear trough filler should be one that doesn’t swell too much because swelling under the eyes can be very bothersome. Right now my favorite for this area is Refyne, because it is so moldable and soft. Silk works well too, as long as you are not using too much of it in this location. Most people do not need more than one syringe of filler for the tear troughs. I have heard some horror stories of people getting the wrong filler or too much filler in this spot. One patient told me that she’d had 6 syringes of Voluma placed under her eyes, and she had records to prove it. This was not only the wrong filler, but way too much of it! She said it was like having life-sized sausages there.  It took multiple visits to dissolve it, and even then her eyes were swollen for more than a year. Needless to say, she has sworn off filler forever. But used properly, filler  can be safe and very helpful to improve the look of tired, sunken eyes.

For the lower face: the nasolabial folds, marionette lines and perioral lines, it is important that the skin be flexible enough to make normal facial expressions. That’s why I like Refyne and Defyne so much for these areas. These are fillers designed both to hold their shape and to be flexible (think of a gumby doll). JUVÉDERM® Ultra Plus, Restylane® L and a new filler called Revanesse® Versa are all good options for the lower face as well.

There are a few fillers that I choose not to use  in my practice:

JUVÉDERM VOLBELLA®: initially I loved the way this filler worked. It is similar to Silk but swelled a little less and came in half syringes. It was very popular. However, there have now been multiple reported cases of late painful nodules with repeated use of Volbella, and I have discontinued its use.

JUVÉDERM® VOLLURE: I was never a great fan of Vollure due to its price point (expensive) and its inferiority to Refyne and Defyne in the lower face, and now there are reports of late complications with it, similar to those of  Volbella. We no longer offer it.

Radiesse®: this is a calcium hydroxyapetite filler that is non-reversible. Because you can’t dissolve it, it is less safe than the Hyaluronic Acid fillers. We no longer offer it.

Belotero®: this is a very nice soft filler like Silk, but it does not last very long (only a few months). It just wasn’t worth the money.

Bellafill® (AKA artefill): this is an artificial “permanent” filler that lasts 5 years or more. This is also non-reversible, and especially unsafe because you cannot get rid of it from the body other than surgically.

As I said at the beginning of this post, every injector has favorites. I base my selection of what filler to use based on the needs of the patient, location of injection and safety. If you are interested in finding out more about fillers, we are happy to help. Call us at 206-800-7379 or schedule a consultation here.

I will never give someone ducky lips. I simply do not believe that ducky lips make people look beautiful. How is it that we see more and more people looking overstuffed with fillers? Giant ducky lips, huge cheeks, a lower face that doesn’t really move when they talk. These things do not look natural and often are so distracting, one spends more time thinking about why this person looks so odd than listening to what they are saying. So why does this happen?

As you age, you lose volume in your face. When we are kids, we have fat pads that round out the face and give us a baby-face look. As you get older, you lose those fat pads over time. Eventually, you get hollows and areas that look scooped out. Fillers are one solution that can help replace volume. And when done well, they can really make you look younger. Fillers are a great tool, but they are not the only tool.

The big process that contributes just as much to aging is the thinning of the skin. After around age 30, the cells in your dermis that make collagen and elastin go dormant. Your body breaks those down at 1-2% per year, so after that, your skin is slowly thinning out. As it thins, it is no longer thick and springy, and it starts to sag. Here’s the problem: many injectors use fillers to prop up this sagging skin. It is like adding a few tent poles under stretched-out tent fabric. The results can be dramatic, and they are instant (although temporary). But what happens over time as your skin continues to thin out? You need more and more filler to prop it up.

If the only tool you have is filler, you end up chasing this increasing problem of sagging skin with more and more filler. Eventually, you look ridiculous and you still have not addressed the real problem – a loss of collagen and thinning skin. Places that do not offer other tools, or have an approach more focused on creating repeat filler customers, are missing the opportunity to address the whole problem, and they are overstuffing people in the process.

At Glow, we believe in preserving your natural beauty. We use a combination of approaches to tighten skin and replace volume that makes you look like you, just a bit younger. Yes, we still offer filler – it is a great tool! But we also focus on building your collagen with tools like Infini, LaseMD, Exilis Ultra, PRP and microneedling, and Sculptra, a non-filler injectable that also builds collagen. Check out this blog post about “How to keep your skin thick and springy.” Taking great care of your skin is also critical to keep it looking young and healthy. At Glow, we are looking at the big picture for the long-term. By educating our clients and using our natural approach to beauty, we hope we are helping you to feel great about your skin.

We live in an exciting era of advances in cosmetic medicine. Many non-surgical treatments have come online that allow us to slow or even reverse the development of wrinkles that can leave us looking older than we actually feel. One such non-surgical wrinkle treatment is fillers.

Your Skin and Aging

As we get older, our bodies begin producing less of certain substances that promote youthful, radiant skin. One of these substances, hyaluronic acid, acts as an internal moisturizer. It exists in abundance in soft tissues, like the tissues in between our joints. Here, hyaluronic acid acts as a kind of shock absorber, cushioning impacts that might otherwise damage our joints.

In the skin, hyaluronic acid absorbs and holds water molecules so that each individual skin cell is properly hydrated. This allows the cells to efficiently remove waste and remain plump. Skin with adequate hyaluronic acid appears moist, plump, and radiant.

Unfortunately, our bodies produce less hyaluronic acid as we age, leading to the development of skin that is often dry, thin, and displays prominent wrinkles due to the loss of the moisture once provided by hyaluronic acid.

Hyaluronic Acid Dermal Fillers

Hyaluronic acid dermal fillers are injectable formulas that can help replace depleted hyaluronic acid. Once injected into the skin, these dermal fillers can reabsorb water into skin cells and help reverse the process of depletion.

There are a variety of hyaluronic acid dermal fillers available, containing varying amounts and concentrations of the active ingredient in gels of different consistencies. Some even contain lidocaine to aid in the comfort of the patient during their treatment.

It is important to remember that dermal fillers offer impressive results, but these results are temporary. The ingredients of the injections will eventually be absorbed by the body and require replacement to maintain results.

Contact Us Today to Learn More

If you are considering using dermal fillers for non-surgical wrinkle treatment, make an appointment to talk to our medical staff at Glow Medispa in Seattle. We will answer any questions you have and help you determine which dermal filler is right for you. Contact us today to schedule a consultation and regain your youthful appearance.