LAM FACIAL PLASTICS

Hi Dr Lam,
I am 31 with hollow under eye circles. They have always been there but getting worse as time goes by.I have very fair skin.
I have recently visited two Dr's for a consulation for under eye fillers. The first Dr said my skin is very thin with veins visible and too pale. She said as a result the likelihood of bad bruising from the needle hitting a vein was nearly 100% and that there was a likelihood Restalyne she used would show a blue tint.So she said it would be best not to do any Restalyne.She said that is the only filler she works with. At the same time she tried to sell me an at-home gadget to increase volume. This annoyed me a little as it seemed she had an ulterior motive. But at the same time not sure if her advice on bad brusing/blue tinge was true given my thin skin.

Anyway,the second Dr says she can achieve a very good result using Juvaderm Voluma. She said the chance of lumps are basically zero as she also has a special machine to dilute the voluma. She would inject the voluma deeply using a blunt needle. She said the technique is a no bruise technique.. whereby introducing the needle through a pin prick at cheek level and then feeding this blunt needle which weaves it's way around blood vessels
How does this second technique sound to you? Have you heard of Juvaderm Voluma being used to fill the undereye area successfully?

Thank you I would really appreciate some advice

we don't have juvederm voluma in the US yet so it is not legal here at least. no experience with it. but the blunt cannula is the way to go. i do it that way myself. the first doctor is also right. with restylane or juvederm you do risk some blue tint if you put it under thin skin. i always go conservatively with these products under thin skin and always use a blunt needle as the second doctor suggests. i have been happy with Artefill under the eyes because I don't see the blue tint but it is twice the price also it is permanent which you have weigh for yourself considering your young age.
best,
s.

Thanks Dr Lam for your reply. Artefill sounds interesting, I have never heard of it. I will research it.Possibly no one does it where I live.
Just wondering about recovery time of your patients when using the cannula method.Is there usually swelling and is there ever brusing? I am thinking of having it done Jan 3rd but leave for a holiday Jan 10th. In your opinion should all the swelling be gone by then? If there is a possibility it wont be gone I will be patient and wait until I return from holiday.
Hope you have a wonderful Christmas

hi,
1. always a risk for one 1 week but if done by skilled injector with blunt microcannulas the risk is on the lower side. with needles if you get unlucky you could be bruised for a month.
2. artefill is permanent. only the top 0.5% of injectors should be doing it around the eyes and it should be done with cannulas. stay safe.

s.

Voluma attracts a lot of water and you risk getting puffy under the eyes. I had it in my cheeks and it whether migrated or is just so good at attracting water, I constantly have puffy eyes. I say don't take the risk.

i heard the same thing about voluma. am waiting when it comes stateside to judge.

Any suggestions for dealing with the puffiness? The bags are the same shape as I had before but bigger. Skin is now looser and more wrinkled too. It is either / or a combination of migrated filler or general puffiness from filler in my cheeks. I think its a combination as both eyes are puffier than before plus on one side i can feel granules / lumpiness in under eye. Unless I resolve the puffiness, I cant see how a bleph would be a good idea right now as i am guessing puffiness would persist. I could wait it out but it might take years (voluma is long lasting) or never resolve. It's worse in the morning. Any ideas?

if it is worse in the morning then typically you are dealing with lymphatic obstruction and possibly some lymphatic massage may help. if it is just generally puffy all the time, then a dissolve of the product may be advisable. keep in mind that my philosophy today is to be very careful with dissolving things because it can lead to over dissolving which could take months to be resolved if not longer. i am very cautious with the use of Vitrase/hyaluronidase when working on an area of overfilled HA filler.