Dr. Gal Aharonov Facial Plastic Surgery Blog

Facial Plastic Surgery Blog by Dr. Gal Aharonov

Non Surgical treatment for sunken in eyes (Enophthalmos) with fillers

December 12th, 2013

Enophthalmos is a condition when the eyeball itself is sunk into the orbit too deep. This could be a congenital problem that one is born with, due to a disease process such as silent sinus syndrome, or a traumatic event such as a broken eye socket. This condition is usually corrected by placing tissue inside the eye socket to push the eyeball back out surgically. There is now a non surgical option of using injectable fillers to fill in the space and slowly push the eyeball back out. This could be done as an office procedure while the patient is awake and can take as little as a few minutes to perform.

What is Voluma and how is it different from the other fillers?

December 12th, 2013

Voluma is a newly FDA approved Hyaluronic Acid based filler distributed by Allergan. It has been available in Europe for years. It is approved for cheek volumization and lasts up to 2 years based on studies. Voluma has a slightly thicker more viscus consistency and displays more lifting capabilities, which means you can achieve more contouring with it compared to Juvederm Ultra. It might be too thick for areas such as the temples or lips, and is not a good filler for fine lines or wrinkles. It is meant for volumization. It is too early to tell if it is a good filler around the eyes. Classically the other available Juvederm formulations are not recommended fillers around the eyes.

Why is it that as the day goes on my eyelids look more and more droopy and my eyes look more hollow? If I get a good night’s sleep my eyes actually look good first thing in the morning but then get hollow progressively as the day goes on.

December 2nd, 2013

This is a very common question I get asked. When you wake up in the morning your face and eyes are more puffy as you have been retaining more water in your face. This extra volume fills in your loose skin and plumps everything up. As the day goes on your face gets less and less puffy causing your eyes to look more hollow and your eyelid skin to be more droopy. If you like how your eyes look first thing in the morning a good treatment is to add volume using a filler. This will keep your eyes looking fresh throughout the day. You will still have some fluctuations with swelling even with the filler, but it will still be fuller at the end of the day.

Non Surgical Upper Eyelid Retraction Treatment

June 14th, 2013

Upper eyelid retraction is when the upper eyelid is raised showing more of the white of the eye and causing the eye or eyes to seem bigger and angrier. This could be due to many reasons. A common reason is from Grave's disease or other thyroid ailments. Patients with upper eyelid retraction can have a surgical correction to try to release the upper eyelid and close it a bit. There is a nonsurgical alternative to mild upper eyelid retraction that can be done with a few quick injections.

Is there any risk of blindness with fillers around the eyes?

March 1st, 2013

This is a question I have been asked many times, and seems to be a common concern in the general population. This concern stems from just a couple of cases that have been reported in the medical literature about blindness occurring after injection of filler around the eyes. This is something I have never seen in my own practice. Why could this have happened? Well, there are theories concerning the filler accidentally being injected right into a major vein that also connects to the eyeball. I do know that injection technique is extremely important especially around the eye. Sometimes I have been shocked by witnessing extremely poor injection technique by some physicians and nurses. Fillers are tools for technicians to use. Poor technique is truly the reason for the majority of complications. Some complications like bruising and swelling are sometimes inevitable and luck based. Lumps should rarely occur if injected well. Again, I have injected thousands of eyes and have yet to ever witness a major issue like blindness. Is it possible? Sure. But I would put the probability at an extremely low level in an experienced injector's hands.

Is it possible to do an upper eyelid surgery and put filler in the upper eyelid at the same time? I feel that I have extra skin and that I am hollow.

February 27th, 2013

It is possible to do a blepharoplasty (upper eyelid surgery) and at the same time add volume to the upper eyelids and brows. Natural aging consists of volume loss in the brow pad and upper eyelids. Sometimes there is also increased laxity or relatively too much skin which ideally would be trimmed away as well. Depending on the particular case, sometimes a blepharoplasty is needed, sometimes just filler, and sometimes a combination of the two.

With the forehead reduction surgery, do the brows get raised? I do not want my eyebrows to be any higher.

February 27th, 2013

With the hairline lowering surgery, or forehead reduction surgery, the eyebrows are NOT raised with my technique. I cannot speak for other surgeons who's techniques can raise the eyebrows, but with my technique there is NO chance of that happening. Some people actually would like higher brows. For them it is possible to combine a browlift with the forehead reduction at the same time. That is an additional procedure though.

Importance of temples in facial rejuvenation:

January 11th, 2013

One of the most over neglected and under appreciated parts of the face when it comes to facial rejuvenation are the temples. As we age, the temples tend to narrow and hollow out, shifting the balance of the face downward towards the mouth and lower cheeks. This gives our cheeks the appearance of it drooping and sagging and changes the harmony of our face. Injecting either filler or fat into the temples is a quick and simple way to give the face a more youthful harmony. Carefully examine your old photos when you were younger and pay close attention to the width of the temples compared to now. It is possible to pick up subtle differences even in your 20's.

Temple rejuvenation usually goes hand in hand with both upper eyelid and brow rejuvenation as well as with cheek rejuvenation. It is important to keep these structures well balanced and in harmony with one another otherwise treatments can look unnatural and fake.

How long does it take for filler around the eye to look good after injection?

July 30th, 2012

This could vary from person to person and from issue to issue. There are different reasons to inject filler around the eye such as under eye bags, under eye hollowness, upper eyelid hollowness, and upper eyelid laxity and droopyness. Filler needs to be injected in different ways to correct each of these issues. That is why there is no standard way to inject filler that is applicable for every issue.

Different people will react to filler differently. Some might swell a large amount, some might not swell at all. Some will not bruise at all, some might have significant bruising. Sometimes it is just luck, other times people might have a propensity to swell or bruise.

It also takes filler a few weeks to soften up and feel more natural. In thicker skin areas this is not a noticeable issue, but around the eye the filler might be palpable and sometimes noticeable for a few weeks.

Injections around the eyes should be taken as seriously as surgery at times. True, a majority of people will look great almost immediately and not have any problems, but a small number of people will have significant swelling and bruising. Make sure you are mentally prepared to maybe be one of those people before deciding to have injections around your eyes. Just because your friend came to me and looked amazing the next day doesn't mean that you are guaranteed to have the same result.

My left upper eyelid is more hollow than the right. When I was young they both looked symmetrical. How can I make my left eyelid look like my right again?

June 20th, 2012

It is very common to have a slowly developing asymmetry to certain parts of the face. The upper eyelid is a very common place to see asymmetries that were not present at a younger age. Patients always ask me why one side is aging faster or losing more volume than the other. A few theories might be that the left side of the face in our country is exposed to more sun while driving. I have had patients that had severe burns on one side of the face when they were younger which sped up the volume loss on that side.

The best way to deal with upper eyelid asymmetries due to volume loss is with filler. Filler is way more accurate than fat or anything else that is currently available. To correct an asymmetry of the upper eyelids usually only a small amount of filler is needed. This can usually be done with just one treatment, but occasionally a touch up might be needed once the swelling settles to get it as perfect as possible.

There sometimes is an asymmetry in the actual amount of upper eyelid skin. If this is the case filler can be used to make the creases appear more symmetric, but the eyes will never be entirely symmetrical unless the superfluous skin is removed surgically.

The biggest indicator of upper eyelid symmetry is the position of the crease, more so than actual volume or amount of skin. The amount of eyelid that is seen is the most critical element. Usually even if there is an asymmetry in the amount of eyelid skin, or even mild ptosis of the eyelid on one side, the eyes can be made to look more symmetrical by adjusting the amount of eyelid show.

To learn more about upper eyelid fillers you can visit our upper eyelid filler page.