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Under Eye Bags, Dark Circles & Lip Augmentation Treatments Using Subdermal Fillers

A significant part of our practice involves the use of injectable fillers for non-surgical facial rejuvenation. We call this “minimally-invasive facial aesthetics.” We use both hyaluronic acid fillers — such as Juvederm, Perlane, Restylane, Voluma, Volbella, and Belotero — and non-hyaluronic acid fillers — such as Radiesse — to enhance certain parts of the face.

Both women and men visit us looking for ways to rejuvenate their facial appearance; most often, their concerns are helped using subdermal fillers. Nowadays, both women and men wish to have their eyelid and face refreshed with fillers. The most common place for subdermal fillers for both women and men include under eye bags, cheeks, nasolabial folds (folds between the nose and corner of the lips), lips, and the midface, when there is loss of volume due to aging.

These types of fillers are known as hyaluronic acid (HA) fillers. They improve the facial appearance by lifting and adding volume to the wrinkles and folds in the treatment area.

Facial Fillers Can Be Used To:

  • Help to restore volume and fullness to the eyelids and face
  • Improve cheek volume loss
  • Improve under eye bags and hollowing
  • Improve jowling
  • Improve temple volume loss
  • Improve Face and neck wrinkles
  • Plump thin lips, or enhance lips
  • Improve the wrinkles around the lips (peri-oral wrinkles)
  • Improve the temple hollowing
  • Enhance the chin area
  • Enhance shallow contours
  • Soften facial creases and wrinkles
  • Improve the appearance of recessed scars

Common treatment areas include:

1) Cheek bones; loss of bone and soft tissue around the cheeks can result in the worsening of nasolabial folds and jowling. Fillers to the cheeks can not only rejuvenate the cheeks but also improve also areas of the face including the nasolabial folds, under eyes, marionette lines, and jowls. Majority of people that come see us for nasolabial folds will have a great result with just cheek fillers alone!

2) Nasolabial folds: folds between the nose and the corner of the lips. Once the cheeks have been adequately augmented and there are still nasolabial folds that need attention, direct injecting fillers into the folds can be performed.

3) Under eye hollows, periorbital volume augmentation. Injectable fillers can carefully be used to improve the hollowing along the under-eye area. Hollowing, or volume loss, usually occurs with aging and injectable fillers provide a very satisfactory result in improving the area. Under eye hollows can also be termed tear trough deformity, dark circles, or under eye bags. Hyaluronic acid fillers do very well in the eyelid area and can offer great results in cases of hollowing under the eyelids. If there are prominent fat pockets in the lower eyelids, you may be a better candidate for lower lid blepharoplasty. Dr. Zoumalan can help determine that for you during your consultation.

When it comes to periorbital rejuvenation, Dr. Zoumalan does not just address the under-eye area. The upper eyelids, lower eyelids, eyebrows, cheeks, temples, and midface are all areas that Dr. Zoumalan will evaluate and determine if volume loss has occurred and help improve the overall periorbital area.

People that have hollowing in their upper eyelids can also benefit from upper eyelid injectable fillers. The eyelid area is very delicate and requires a skilled expert to help augment this area. Dr. Zoumalan is one of a few surgeons in the country that has the experience in the eyelid area, having injected thousands of patients around the eyelid area.

4) Lip augmentation is a very popular area to inject. As a skilled injector and a trainer for other doctors, Dr. Zoumalan has studied the lip anatomy and lip aging process in much detail. Dr. Zoumalan performs lip fillers for various conditions:

  • Over lip volume augmentation for thin lips
  • Asymmetric lips
  • Enhancement of the lip borders and lip philtrum (the columns of raised skin between the nose and the central upper lip)
  • Improve the corners of the lips to give a more upward turn (termed ‘happier” lip)
  • Improve the wrinkles in the lips and surrounding peri-oral area
  • Plumping lips to give them more of a youthful look
  • Elegant enhancement of the lips where patients do not wish for a plump look but a fuller look

Different Types of Facial Fillers

There are various types of fillers that can safely be injected to improve the appearance of the face. Injectable fillers include a variety of materials, which last for different lengths of time and have different effects and uses. Hyaluronic acid fillers such as the Juvederm family (including Voluma, Volbella, Juvederm Ultra and Juvederm Ultra Plus), Perlane, Restylane, and Belotero work very well in selected parts of the face since they are safe and well tolerated in the skin. Each one is used in specific parts of the face based on Dr. Zoumalan’s experience and the patient’s exam findings.

Hyaluronic acid fillers are injectable fillers that include hyaluronic acid, a natural complex sugar that bolsters skin elasticity, providing a smooth and supple appearance. It is biocompatible, supplementing the body’s natural hyaluronic acid, which age has depleted. Hyaluronic acid fillers are transparent gels that are injected with a syringe into the mid- to deep dermis of your face. Dr. Zoumalan also uses Radiesse in select cases of facial volume augmentation.

Fillers of Specific Areas

Fillers to specific areas of the face can certainly help in improving the volume deficiency people get with aging. Fillers are performed in the office with the assistance of a topical anesthetic. The procedure can take as little as 30 minutes if using hyaluronic acids (i.e. Restylane or Juvederm) and patients usually go home afterward without any problems. Dr. Zoumalan has introduced the use of a blunt-tipped cannula for most of his facial filler injections, which allows him to reduce the incidence of bruising and discomfort by a significant percentage in his patients.

The results are overwhelmingly incredible and the patients are extremely comfortable during the procedure with just the use of a topical anesthetic. The blunt-tipped cannulas Dr. Zoumalan uses for his facial filler injections are like the ones used in the operating room for fat grafting procedures, which has made the transition to using the cannulas in the office quite feasible. We offer this to all our facial filler patients and most if not all prefer the blunt-tipped cannulas due to comfort, safety, and decreased rate of bruising.

The Dermis Layer

The dermis is the subsurface skin layer that contains connective tissue, nerve endings, sweat and oil glands, and blood vessels. The advantage of using hyaluronic acid fillers such as the Juvederm family (Volbella, Voluma, Juvederm Ultra and Ultra Plus), Perlane, and Restylane is that they can offer long-lasting outcome without risks associated with permanent fillers and they can be safely repeated. Side effects with Juvederm, Perlane, and Restylane are rare, but may include redness, tenderness, or pain at the injection site.

If these occur, they usually subside within three days. Rarely, discoloration may occur, but this is reversible. Firmness, swelling, bumps and bruises are also rare side effects, and should subside within seven days.

Are You a Good Candidate for Facial Filler?

You may be a good candidate for facial fillers if you:

  • Are physically healthy
  • Have volume loss in certain areas in your eyelid and face
  • Live a healthy lifestyle and take good care of your skin
  • Maintain Realistic Expectations of the results
  • image

    Preoperative diagnosis: Mild to moderate volume loss in upper lips.

    Procedure performed: Hyaluronic acid (HA) fillers were used to augment the upper lip to allow for a more natural and youthful look. A total of 0.6ml of Juvederm filler was used.

  • Hyaluronic Acid fillers are used to create a more appealing upper lip

    Preoperative diagnosis: Mild asymmetry in upper lip volume (left upper lip has less volume than right upper lip).

    Procedure performed: Hyaluronic acid (HA) fillers were used to augment the upper lip and in order to achieve a more fuller and symmetric look.

  • Hyaluronic acid (HA) fillers used to better define the jowl lines

    Preoperative diagnosis: Jowl lines.

    Procedure performed: Hyaluronic acid (HA) fillers were used to better define the jowl lines.

  • image

    Preoperative diagnosis: Lower eyelid bags (ie lowereyelid fat prolapse, right worse than left). Loss of midface volume.

    Procedure performed: Hyaluronic acid (HA) fillers to the orbital rim (tear trough) and midface. In this patient, Restylane was used below the eyelid bags. Juvederm was used to augment the midface and to restore the volume that had been lost. Pre and post photos are shown above.

  • image

    Preoperative diagnosis: Facial wrinkles, lower lid rhytids (wrinkles) and tear trough hollows (ie dark circles).

    Procedure performed: Botox to forehead and crows feet, hyaluronic acid (HA) fillers to the tear trough area and midface, 30% trichloroacetic acid (TCA) chemical peel to lower lids.

  • image

    Preoperative diagnosis: Tear trough deformity (orbital rim hollowing) and loss of midface volume. The dark lower lid circles are a result of a loss of volume in the tear trough area and a result of some “extra” fat that has herniated.

    Procedure performed: Hyaluronic acid (HA) fillers to orbital rim (tear trough) and midface.

  • lower lid

    Preoperative diagnosis: Tear trough deformity (orbital rim hollowying) and loss of midface volume. The patient has visible eye bags, right worse than left. The dark shadows are a result of a loss of volume in the tear trough and also a result of “extra” fat that has herniated.

    Procedure performed: Hyaluronic acid (HA) fillers to orbital rim (tear trough) and midface.

  • image

    Preoperative diagnosis: Tear trough deformity (orbital rim hollowying) and loss of midface volume. The dark shadows/circles are a result of a loss of volume in the tear trough and not a result of “extra” fat that has herniated. This image is snapshot image taken from our 3D imaging system.

    Procedure performed: Hyaluronic acid (HA) fillers to orbital rim (tear trough) and midface. In this patient, Restylane was used around the tear trough and orbital rim. Juvederm was used to augment the midface and to restore the volume that had been lost. Pre and post photos are shown above.

  • Use of restylane was used to eliminate the dark shadows and circles

    Preoperative diagnosis: Lower lid fat prolapse (ie bags under eyes). History of prior blepharoplasty with residual fat pads. Loss of midface volume.

    Procedure performed: Hyaluronic acid (HA) fillers to orbital rim (tear trough) and midface. In this patient, Restylane was used around the tear trough and orbital rim. Juvederm was used to augment the midface and to restore the volume that had been lost. Pre and post photos are shown above.

  • image

    Preoperative diagnosis: Lower lid fat prolapse (ie bags under eyes) and loss of midface volume.

    Procedure performed: Hyaluronic acid (HA) fillers to orbital rim (tear trough) and midface. In this patient, Restylane was used around the tear trough and orbital rim. Juvederm was used to augment the midface and to restore the volume that had been lost. Pre and post photos are shown above.

How many syringes do you need and what are the cost of fillers? This is a fairly common question and it all depends on how heavy your folds are and to what level of improvement you wish to achieve. Some end up using one syringe while others require more than 3 syringes. The price range per syringe is anywhere from 600-800 dollars and depends on the type of product and size of syringe. How long does it last for? After 9-12 months, the biocompatible compound is naturally absorbed into the body. However, some patients find improvements that last up to 1-2 years.