As one ages, the characteristics of the eyes change in generally predictable ways: the skin thins and becomes less elastic, brows may descend, the upper lid may recede or enlarge, and the bones around the eyes appear more prominent. While surgery has long been the accepted standard and offers significant benefits to many patients, injectable treatments are proving to be a viable option for taking years off the appearance of aging eyes. An article appearing in the current issue of the Aesthetic Surgery Journal, a publication of the American Society for Aesthetic Plastic Surgery (ASAPS), details the use of hyaluronic acid (HA) fillers as a reliable and long-lasting method for improving the eye area.
“In some cases, the addition of volume may provide a better-looking result than traditional surgical procedures,” says Val Lambros, MD, author of the article and a plastic surgeon practicing in Newport Beach, California. “Although the upper lid can be improved with injections, the area we treat is the brow. In some cases, filling in the brow expands the lid skin sufficiently to smooth wrinkles.”
According to Dr. Lambros, adding volume in the brow area can make the eye appear longer and fuller with less upper lid showing, all characteristics of a youthful eye. However, as in all cosmetic procedures, there is no “one size fits all” approach. “These are true aesthetic choices that must be decided through the patient’s consultation with a board-certified plastic surgeon,” advises Dr. Lambros.
Since the 1980s, the standard method for volumizing the brow line has been by fat injection. Excellent results can be achieved using this method. The risk with fat injections, however, is that over time some of the fat may not survive. In some cases, the injected fat may actually grow as the patient ages or gains weight, resulting in unevenness in the brow area.
Hyaluronic acid has been used to treat the brow and upper lid since its introduction in 2005, using a technique similar to that of fat injections. Dr. Lambros prefers HA to fat for brow volumizing because he says contouring is easier, and HA is less subject to variability than biologic fillers. In the brow area, HA has been shown to produce long-lasting results, extending beyond two years. In addition, the effects of HA can be reversed immediately, using hyaluronidase (an enzyme that degrades hyaluronic acid), should the patient be displeased with the volumization effect.
When it comes to the eyes, a little can go a long way. “Brow volume procedures should not be overdone; more is not always better,” adds Dr. Lambros. “Most candidates for brow improvement with HA elect to begin treatment with small amounts of product, and are very satisfied with the results.”
Dr. Lambros gives patients the opportunity to preview their final look, a benefit not available to patients undergoing surgery. He creates temporary volume by injecting diluted local anesthetic which is threaded into the brow and molded into shape. If desired, the patient can choose to undergo the procedure immediately following the preview, since the brow is already anesthetized.
The use of injectable fillers in the brow is a complicated process and requires great skill and experience. “Because of its dependency on technique, only qualified injectors and board-certified plastic surgeons should be performing this procedure,” states Renato Saltz, MD, president of the Aesthetic Society. “When performed properly and by appropriate medical professionals, the use of HA fillers is safe, effective, and produces long-lasting results.”
The Aesthetic Surgery Journal is the peer-reviewed publication of the American Society for Aesthetic Plastic Surgery (ASAPS) and is the most widely read clinical journal in the field of cosmetic surgery, with subscribers in more than 60 countries.
American Society for Aesthetic Plastic Surgery