I use a blunt cannula to deliver fillers in this area. This method provides superior patient comfort, better placement of product, less bruising in addition to increased safety.

Dermal fillers typically between 9 to 24 months in this area. The longevity depends on the type of dermal fillers as well as how quickly your immune system dissolves the filler. We now know that fillers last a lot longer than what the product says. Part of the reason is that the eye area is less dynamic (less movement) compared to say the lips!

This is the number one area to under-correct. Why? Because Hyaluronic Acid fillers can take up water over time. Hence if absolute correction is achieved (result looks great for a few weeks-months), over time swelling and puffiness may occur. IMO this looks worse than under-corrected troughs. One can always add more filler IF required, however if too much filler is placed, the only solution is to dissolve it all and start all over again.

No. Eye creams have limited value in the management of tear troughs & wrinkles. Creams that contain caffeine, peptides, retinol & vitamin K can marginally improve some cases of ‘dark circles’ when vascular factors contribute to pigmentation.

At the time of writing, I am against eye creams as they do not give a reliable outcome, regardless of price. For patients who want to ‘give it a go’, my recommendations are –

• Budget eye cream: Swisse Eye Cream: Caffeine + Vitamin K + Argan Oil $12 USD
• High End Product: TNS Eye Cream $120-140 USD

Microneedling, Microneedling RF, Derma Rollers & other needling methods have limited value in the eye area. I am not against microneedling as I perform this treatment regularly, what I am against is the safety of this procedure in the context of treating the under eye (or upper lid) areas.

The eye area has the thinnest skin on the body- less than 0.1 of a mm! The use of needles in this area is too traumatic. With a one mm needle, this has the potential to penetrate 10 times the depth of your epidermis. This can result in post procedure bruising or ‘post purpuric pigmentation.’

PRP or platelet rich plasma can be effective in the management of some skin conditions. The eye area – eyelid skin is not one of them.

PRP can improve healing times, however it does NOT improve the volume of the under-eye area. The reason why PRP may give a perception of improvement is the continual swelling of this area. Most clinics sign you up to a ‘series of sessions’, ranging between 4-6 sessions conducted monthly. Swelling in this area (due to both microneedling & PRP) can give you a perception of improvement.

Swelling takes 3-6 weeks to decrease, just in time for your next PRP session. Continue this for 4- 6 months and you are none the wiser; until your last PRP session. Don’t get me wrong, I am NOT against this treatment; PRP has the most amount of evidence in the management of joints, hair loss, and accelerated recovery. It has limited benefits in the management of volume, eye rejuvenation, skin rejuvenation & acne scars.

Tyndall occurs when the skin overlying the filler is blue. Tyndall is due to reflection of the longer wavelengths of red light, with the absorption & scattering of blue light. It is due to incorrect product placement, too much product, & or fillers placed superficially.

If the Tyndall effect is mild & or able to be covered with makeup, nothing needs to be done. If Tyndall is obvious, filler can be dissolved with Hyalase, an enzyme used to break up hyaluronic acid-based fillers. Refilling of the tear trough can commence 2 weeks after Hyalase.

If you do experience Tyndall with low concentration HA, I may elect to use a hyper-diluted solution of Ca OH apatite, often in combination with collagen stimulating energy devices.

Lasers are best utilised for improving skin texture & skin quality. For patients with laxity, lasers can tighten skin before dermal fillers. Tightening of the lower eyelid skin will give a more accurate picture of the depth of your trough & allow for more accurate placement of hyaluronic acid. If there is little in the way of laxity, laser resurfacing will have little or no impact on your trough. 

Laser resurfacing is only one technique I employ to tighten eyelid skin. Fraxel, CO2 & erbium lasers can be used in this area.

RF can also tighten eyelid skin without the downtime of lasers. RF devices I use include Tempsure & Thermage. I prefer the former device due to comfort levels.

Tixel is a novel approach to tighten the eyelid area without the use of laser energy. This is a fractional resurfacing device with less downtime compared to fractional lasers. 

Fat transfer involves harvesting your own fat cells (most often from the abdominal area). The solution is then separated and allowed to settle. Fat cells are then injected into the area of concern using a cannula.

I have used fat in the past, however, nowadays perform this procedure almost exclusively with hyaluronic acid dermal fillers; here is why-

• Firstly, the advantage of fat transfer is that we are using your own ‘cells’ & ‘product’. This is termed autologous fat. Fat can last longer than dermal fillers.
• The disadvantage is that we do not reliably know how much fat will be resorbed by your body. Some patients resorb very little fat, others deplete fat by as much as 50% within months of the procedure
• The main disadvantage of fat is the malleability of the source. Dermal fillers are extremely malleable, meaning fine correction can be achieved. Fat transfer (even nano fat) can result in lumps. Hyaluronic acid dermal fillers have a reversal enzyme called Hyalase. This dissolves HA fillers immediately. It is much harder to remove misplaced fat!

In 2021 I will re-explore fat transfer as new articles have recently been published on newer methods to increase fat or stem cell viability post-transfer. If I am happy with the results I will re-offer fat grafting – fat transfer to select patients. Fat transfer is still a reasonable option for patients who have marked volume deficits.