Dr. Sam Lam Plastic Surgery Forum

Hi Dr. Lam,

I have extremely thin skin under my eyes. I had restylane injected in my tear trough area but even after the two months I can still see product. The doctor even injected deep right above the orbital bone. I was told that because my skin is so thin that can happen.

I did some research and found a product called cosmoderm and it said it is a thinner product recommended for older people with more delicate under eye skin. Do you recommend this filler because it is thinner and does it last?


I also found out about fat transposition where fat slides down into the lower eyelid to transpose the tear trough. I am not too sold on this because it sounds loopy. What are you thoughts because I trust you above most other people in terms of honest answers. Thanks for all you do!!!

i absolutely do not recommend cosmoderm for multiple reasons: 1. it is irreversible which is not great around the eyes especially if you are considering to have fat grafting and i can't convert you. 2. it lasts a very short time compared with restylane. 3. allergan is pulling this product in a year or so, so if you like it hurry up and get it. it will be off the market soon not because it is an unsafe product just one that is pretty close to useless except in defining lip borders more sharply (which i hate. yuck!)

using blunt cannulas around the eyes even for restylane virtually eliminates the Tyndall effect, which you are describing. it is all technique dependent just like fat transfer.

fat transposition is so 1999. if you want to read an extensive description of why i think this is in general a bad idea, please do an archive search. in summary, you are really only transposing fat over the tear trough. how about the other 2/3 of the rim? what if you don't have an excess fat bag, then you have to move the fat bag that does not exist over the rim which can lead to 2 problems: too little fat in the eye and not enough in the transplanted area. what if you need more fat and it is not enough? screwed. what if you get older and you lose more fat there and need more? screwed. it also has a high chance for uneven results but in great hands, i.e., experienced hands you should be okay. but why? when FT is so so so so much better (again in the right hands).

i absolutely do not recommend cosmoderm for multiple reasons: 1. it is irreversible which is not great around the eyes especially if you are considering to have fat grafting and i can't convert you. 2. it lasts a very short time compared with restylane. 3. allergan is pulling this product in a year or so, so if you like it hurry up and get it. it will be off the market soon not because it is an unsafe product just one that is pretty close to useless except in defining lip borders more sharply (which i hate. yuck!)

using blunt cannulas around the eyes even for restylane virtually eliminates the Tyndall effect, which you are describing. it is all technique dependent just like fat transfer.

fat transposition is so 1999. if you want to read an extensive description of why i think this is in general a bad idea, please do an archive search. in summary, you are really only transposing fat over the tear trough. how about the other 2/3 of the rim? what if you don't have an excess fat bag, then you have to move the fat bag that does not exist over the rim which can lead to 2 problems: too little fat in the eye and not enough in the transplanted area. what if you need more fat and it is not enough? screwed. what if you get older and you lose more fat there and need more? screwed. it also has a high chance for uneven results but in great hands, i.e., experienced hands you should be okay. but why? when FT is so so so so much better (again in the right hands).

Hi Dr. Lam,

Thanks so much for your honesty. In your opinion, does restylane stimulate collegan growth because I heard rumors that it does. Also, resty is water absorbing. Does restylane add more depth to the face by the water it absorbs. I get so many answers that are all so different and I am wondering what you think.

collagen growth is overrated and overstated. read my post about my study on a pig. you'll find it a few posts back. search under "roe" for my prize that i won. the water is also overrated. it just looks good. forget the hype, please.
sml

I am sorry, but I did not understand you answer. Every doctor has told me that yes it does stimulate collegan growth.

I just don't want to type out an extremely long answer to a question about collagen growth that I have answered several times already in this forum.

Here's how to find my previous answer: under search type in "pig" (for the animal that i used in my study i am citing), then look at what is currently the third entry entitled "Restylane" by "nick21" and read my response there. i do not want to reprint it here since Google nails people for redundant content in a site.