“Does the doctor give ‘under-eye light fillers’? We will get an appointment depending on your answer.” This conversation has almost become a part of my clinical assistant's daily routine. Well, let's take a look at these "famous", full-of-surprises, under-eye light fillers.

1. The content of the filler is Hyaluronic acid (HA) in a soft and fluid form

Hyaluronic acid is by far the most frequently used substance in subcutaneous-intradermal fillers all over the world. It is a kind of sugar jelly synthesized in the laboratory. There are various manufacturers present, and the product range of each company more or less overlaps with the others. The physical properties of hyaluronic acid such as hardness, fluidity, absorption time, and water absorption capacity vary depending on the chemical stages of the synthesis process. The hyaluronic acid that will be used under the eye should be much softer and more fluid compared to other application areas because the skin under the eye is very thin, and if the substance injected under that skin is hard and has a mass effect, it will most likely be externally visible and create noticeable irregularities. Since obtaining the soft and fluid materials used for under-eye fillers requires different technological experience, these fillers are typically marketed at a relatively higher price.

2. "Light filler" is a marketing term and has no place in medical literature

The name of this procedure in the medical literature is “Augmentation of the junction of the lower eyelid and cheek with fillers containing Hyaluronic Acid”. Now, upon reading this, you may say, "Doc, don't overwhelm us with medical terms", but it is critical to define it correctly in order to understand and explain the nature of the procedure. Because the vast majority of patients get obsessed with this marketing term and are inclined to believe in the existence of a different, unique and miraculous substance called a "light filler". However, that is not the case.

3. Where does this "light/luminescence" originate from?

The light comes from the outside world around you, from the sun and from artificial lighting devices. Luminescence, on the other hand, occurs when this light reflects off a surface and reaches the eye of a person to perceive it. As we age, bags form under the eyes, the soft tissue covering the bags loses volume and becomes thinner. Thus, hollow areas and grooves that separate these bags from the surrounding soft tissue begin to appear around the bags. Tear through deformities emerge between the lower eyelid bag and the nose, while orbitomalar groove deformities occur between the lower eyelid bag and the cheek. Since these grooves are relatively hollow compared to the under-eye bag, the shadow of the eyelid bag falls on them, and someone looking from the outside sees the convex surface of the bag as the brightest, while the relatively hollow areas around it are shaded. This light shade distribution is the main factor that gives a "dark-purple" impression to the under-eye area. Here, we fill and elevate the relatively hollow areas with fillers and thus eliminate their level difference with the under-eye bags. When a rather even surface is obtained, the reflection of the light from the eye region becomes smoother and more even, and the shadowy areas are reduced. In other words, the substance we apply does not create a shine, a color change or a texture-level glow in this area. We improve the light/shadow distribution of that surface by changing the uneven physical properties of the surface.

4. On the concept of negative volume

You can imagine the under-eye filler procedure as follows. You are playing in the sand, and there is an orange on the sand. You are trying to bury this orange under the sand without ever changing its place. In other words, you have to pile the surrounding sand around the orange until the orange is completely under the sand. This area where you pile the sand around the orange is what we call negative volume. Regarding under-eye fillers, you can think of the orange as your under-eye bags, and the area where we pile up the sand as the area where we apply the filler. Typically, the total volume you need to use to camouflage a mass with a natural contour is greater than the volume of that mass. Therefore, it is necessary to go up to relatively higher volumes to achieve an effective result under the eyes.

 

 

5. The application technique is highly specific

It is necessary to go up to relatively higher volumes to achieve an effective result under the eyes. That is exactly where the problems start. High volumes are typically much more prone to complications, and the practitioner must be very experienced and know what they are doing. Most practitioners distribute 1ml of filler under both eyes. This amount is quite small and relatively safe. The problem is due to post-application edema, this volume initially seems sufficient, but within a few weeks, after the edema dissolves, patients complain that the filler was not enough and melted away, adding that they could not get the result they wanted. In higher volumes, bulges and visible irregularities may occur due to the ponding of the filler in a specific area. In my practice, after 3-4 cc of filler is specially diluted and gains a more fluid and softer form, it is applied in layers not only to the visible troughs but also to the entire anatomical unit and is distributed very meticulously. In practice, we use a flexible cannula with a non-pointed tip to avoid the possibility of intravenous injection. Each time the cannula passes through the tissue, it distributes the filler into the tissue, injecting very small volumes. If the filler is not distributed in this way, it is impossible to obtain a natural result.

6. After the application, your under-eye region will be noticeably bruised and swollen

When you apply the filler using the technique I mentioned above, that is, when you distribute it into the tissues, it is inevitable that there will be a slight but significant swelling and bruising around the patient's eyes which will last for about 5-7 days. Unfortunately, after the application, you won't be able to leave the clinic and immediately meet friends for lunch.

7. The application is only suitable for early aging deformities

Under-eye fillers are definitely not suitable for advanced aging deformities due to the reasons I previously referred to. It should only be used in early deformities, that is, in patients whose skin does not have many wrinkles, muscle layer is not loosened and volume loss is not advanced and whose bags are only slightly distinct.

8. Learn about other options

Under-eye fillers is just one of the many options among periocular applications. A conscious patient should not focus on one single option and ignore professional opinions just because that option is successfully marketed. When you consult with your plastic surgeon, listen carefully to what they have to tell you. It is possible to apply a treatment under the eye using your own tissue (microfat / nanofat). Anatomical changes sometimes occur at very early ages in anatomically-predisposed individuals and can be permanently removed by surgery regardless of the patient being young. It may sometimes be necessary to tighten the eyelid surface or at other times it may be required to treat bags, muscle laxity and excess skin with lower eyelid surgery. Therefore, fillers are never an alternative to surgical treatment, neither under the eye nor elsewhere.

9. Complications can be annoying

The most common complication with under-eye fillers is the slightly bulging accumulation of the filler under the eyelid skin. For the patient, this may be a greater source of dissatisfaction than the original complaint that got them to see their physician. Loss of vision has been reported in terms of periocular applications, albeit rarely, and I never ever recommend that such applications be performed by non-specialists.

10. No filler has yet received FDA approval for under-eye injection.

For any substance to be used for medical purposes, it must be thoroughly examined, approved and inspected by authorized authorities such as the FDA, the European Standards Institute, and the Turkish Ministry of Health after market launch. We can say that the more the number of institutions giving approval, the safer a drug or medical device is. It is useful to know that the American FDA has not yet approved the periocular injection of any fillers. No fillers injected under the eyes in the US? They are definitely injected. However, this is called “off label” use. If you have any complications, you can't just complain and say, “Hey, I didn't know that. I was never told about it.” Potential problems regarding under-eye injections indicate that health authorities in developed countries will not approve this indication for a long time.

Take good care...

... of yourself and your beauty.