Dr. Sam Lam Plastic Surgery Forum

the area between the eyes can be a less than safe area. that is why i spend 10 to 15 minutes explaining to a patient the risks and keep on hand nitropaste in case there is a problem when dealing with the area between the eyes (no where else but in this area). the problem is that the skin can slough because it is an area that is sensitive to blood supply. do i do it? yes, i do it only with restylane and juvederm so that i can reverse the area if it is a problem. due to the extremely rare but real risks in this area, there are 3 things you should consider when picking a surgeon to do this sensitive area: 1) do they have experience doing this area? 2) have they warned you about the risks and explained to you what you need to look out for if there is a problem, 3) do they have hyaluronidase and nitropaste in the office to manage a problem should it arise. if the answer is no to any of those 3 questions, i would be careful in having injections in that area done. in general, i think juvederm tends to spread too much so i prefer restylane for discreet areas like that. the carruthers' study looked at the fact that restylane in that area can be doubled as far as longevity with the use of ongoing botox. i agree with that. in general, you can snip the muscles, cut the line out, dermabrade, etc. i think most of these are drastic now that we have botox and restylane. but if the line looks like a crater then botox might be too late and even restylane might be too late. in those circumstances, i cut the line out with a geometric broken line repair (see scar revision faqs for that discussion) but think that is entirely overkill in 99% of cases. i always say let the punishment fit the crime. if you have a fine line then these surgical treatments are too invasive for you. if it is a deep crater, then it might be the only option and worth it. judgment and experience are everything in this case. ongoing botox should soften 90% of bad lines out there. keep on the botox train.

wishing you the best.

it can turn dark and die. that is why anyone injecting this area should give proper warning, proper follow-up care, and be experienced. the risk is probably 1:10,000 but it is something that an injector should know about and warn a potential patient. i have many ways to prevent and to correct the problem before it becomes an issue.

did not see that but answered that in a PM. basically anything below the deepest set portion of the nose (top of the nose), you are okay. above that, there is a slight risk.

for tear troughs i either use restylane (temporary) or fat (permanent). juvederm has a bit of a risk of prolonged swelling and slight migration. perlane is a bit too thick for my taste in that area although fine for other areas of the face.