Secrets of successful correction of the lower eyelid with HA fillers

provide good aesthetic results for the correction of the periorbital area, including the lower eyelid. However, to achieve the desired effect, it is necessary to follow a number of rules that will ensure the safety of the patient when working in the delicate area around the eyes. In this article,

talks about important points to consider when correcting lower eyelid aesthetic imperfections with hyaluronic acid fillers.   Who is contraindicated for the procedure of lower eyelid correction with HA fillers

Contraindications for HA fillers in the eye area include the following:

•    high patient expectations;

•    swelling of the lower eyelid;

•    tendency to edema of the eyelid or zygomatic zone;

•    excessively thin skin.

In order to avoid deformation or displacement of the filler, the author recommends laser or RF correction at least one month after HA injections.

Instagram! A week before the injection of fillers, patients are advised to stop taking blood-thinning vitamins, medications (if these are not vital), alcohol, or nutritional supplements. However, the author notes that safe correction with fillers is possible while taking blood-thinning drugs, especially when using a cannula.

Safety rules for correction of the periorbital zone with HA fillers

To ensure patient safety when injecting HA fillers into the area around the eyes, the following rules should be observed:

1.    Knowledge of anatomy, in particular, the location of blood vessels and dangerous areas.

2.    Slow and even injection of the drug.

3.    Injection as the instrument is withdrawn.

4.    Control force and speed of insertion: excessive pressure and too rapid insertion can lead to vascular damage.

5.    Deep injection into the periosteum in the lower eyelids, since superficial injection or injection into the orbicular muscle of the eye can lead to contouring of the drug, the appearance of hematomas, swelling or the Tyndall effect.

6.    Using a 22 gauge blunt cannula.

7.    Presence of hyaluronidase enzyme in the practitioner's office.

8.    Ofthalmologist contacts in case of vision problems.

In some cases, a series of small aliquots of filler along the anterior surface of the maxilla is sufficient to correct the lower eyelid. To perform injections in this technique, you can use a cannula, however, when working with a needle, according to the author, the safest is its vertical introduction to the periosteum, followed by a slow injection of the drug. Regardless of the instrument chosen, it is recommended to avoid working in the infraorbital and zygomaticofacial openings.

Filler Correction: Rules for Safe Work in the Periorbital Area Danger zones include: angular, facial, labial, temporal, supraorbital and supratrochlear arteries.

When using a needle, it is important to securely fix it on a syringe with a Luer-lock connection (Luer-lock).

How to increase patient comfort and minimize the risk of vascular complications

Complications due to intravascular injection are relevant for all fillers and autologous fat and are associated with the risk of loss of vision.

The author uses a two-inch 22 gauge cannula (SoftFil, France; DermaSculpt, France) for most periorbital procedures. Cannulas with these characteristics reduce the risk of intravascular filler injection and increase patient comfort.

Another advantage of the 22 gauge cannula is good skin penetration, and two inches of length is sufficient to treat the entire lower eyelid and most of the middle third of the face through a single injection point located in the lateral zygomatic arch, 2-3 cm below the outer corner of the eye and on the same line with the lateral part of the corneal limbus.

The effect after correction of the lower eyelid with dermal fillers, as a rule, lasts for 1-3 years.

At least 600 units of hyaluronidase are always kept in the author's office in case of vascular complications after the introduction of HA fillers. After injections of dermal fillers, patients are always asked about the possible occurrence of hematomas, skin discoloration, discomfort or visual impairment, so that in case of complications, the necessary assistance is immediately provided.

How to successfully correct the lower eyelid with HA fillers

The amount of HA filler needed to correct the lower eyelid ranges from 0.2-0.3 to 0.5 ml. The author notes that most patients require an injection of approximately 0.5 ml of the drug (on each side of the face) to achieve optimal results of the procedure.

It is best to perform the procedure when the patient is in an upright position – this allows for more accurate tracking of changes during HA injection.

As a rule, the author first performs the correction of one eyelid, and then, making sure that the result meets the patient's expectations, proceeds to work on the other side of the face. If, after achieving the desired effect, the drug remains in the syringe, the author injects a small amount of it into the tissues of the lateral part of the eyebrow – for volumization, contouring and lifting of this area.

Correction with fillers of the orbital zone is effective not only for skin aging   In the presence of sufficiently pronounced nasolacrimal and lateral palpebromalar grooves, the author resorts to preperiosteal filler injection.

The author does not use local anesthetics in the area around the eyes before the introduction of HA, as they can distort the anatomical picture of the face.  

In case of hypercorrection or contouring of the preparation, immediately after injections of the HA filler, a massage and alignment of the treated area is performed  with a cotton swab.

In order to avoid deformation or displacement of the preparation and, as a result, deterioration of the aesthetic effect, after the procedure, patients are advised to protect the area of ​​the lower eyelid from pressure and friction.

Swelling may occur in the injection area for several days, which can be relieved by cold compresses. When hematomas occur, which happens quite rarely, patients are given IPL therapy to speed up the rehabilitation process.

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