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Join Dr. Zain Husain, Courtney, and Heather in this informative episode of 'Skinside Out: Where Science Meets Beauty,' as they dive into the complexities of treating under-eye concerns. Discover why the under-eye area is so challenging to treat, the anatomical factors involved, and various treatment options for different types of under-eye issues, such as hollowing, dark circles, and puffiness. From topicals such as retinoids and vitamin C to advanced procedures such as microneedling, radiofrequency treatments, and surgical options, this discussion covers it all. Learn how to identify and properly address your own under-eye concerns and explore the multitude of solutions available to help you achieve real skin confidence. Don't miss out on these expert insights and practical tips for maintaining youthful, vibrant skin around the eyes. For more details, visit noorderm.com or follow us on social media @NoorDermatologyandAesthetics.
00:00 Introduction to Eye Creams
00:29 Understanding the Under Eye Area
00:55 Challenges in Treating the Under Eye Area
02:58 Anatomy of the Under Eye Area
04:07 Aging and the Under Eye Area
05:06 Differentiating Under Eye Issues
07:27 Treating Under Eye Circles and Hollows
08:01 Topical Treatments for Under-Eye Issues
09:27 Importance of Sun Protection
11:30 Tips for Reducing Puffiness
13:48 Advanced Treatments and Technologies
16:32 Patient Experiences and Numbing Recommendations
17:20 Chemical Peels: Benefits and Precautions
18:34 Exploring Fillers for Under Eye Hollows
24:24 Biostimulatory Treatments: Sculptra and PRF
27:01 Surgical Options for Eye Rejuvenation
29:34 Upper Eyelid Concerns and Treatments
32:49 Summary and Final Thoughts
Creators and Guests
Host
Host
What is Skinside Out?
Welcome to Skinside Out, where science meets beauty, the ultimate dermatology podcast! Dive deep into the fascinating world of skin health with expert insights, evidence-based discussions, and myth-busting truths. Each episode explores the medical, cosmetic, and surgical aspects of dermatology, while keeping you informed about trending skincare topics. Whether you’re a skincare enthusiast, medical professional, or just curious about how to achieve your best skin, Skinside Out is your go-to resource for staying informed and inspired.
[00:00:00] Default_2026-01-07_1: I always disclose when I'm recommending an eye cream that this is not gonna be a magic eraser for your under eyes. Mm-hmm. Mm-hmm. I think there's only so much that an eye cream can do, and if you're looking for some mild to maybe moderate improvement, you'll get there, but it's not gonna be your fix all.
Real skin, real science, real confidence with Dr. Zane Hussein. Welcome to.
[00:00:24] Default_2026-01-07_1: Welcome to Skin Side Out Science Meets Beauty. I'm your host, Dr. Zain with Courtney and Heather. So have you ever had anyone who told you that you looked really tired or hollow? You kind of look sunken in. So the under eye area is a very cosmetically sensitive area and a lot of people have concerns.
Probably one of the earliest places we see signs of aging. Um, so let's dive into the under eye area, what type of anatomy that we're dealing with, what type of issues that we're seeing cosmetically and how we can fix them. Why is the under eye area so challenging to treat? I think there are a couple things.
Number one, it's um, one of the thinnest areas on our body. It's very low in oil glands. Um, we're constantly tugging at that area. Now you may think, okay, probably the most common. Way I tuck at my face is like washing my face, but actually as we move our eyes throughout the day, um, blinking that can subtly move the under eye tissue and skin and kind of advance aging a little bit quicker.
It's funny, I just think about, , a few years ago before I got glasses for not being able to see far away. My mom would yell at me when I was watching TV to put on my glasses because I was gonna squint and I was gonna cause wrinkles. And I said, oh, it's a good thing. I work where I work and I can just get Botox.
Um, easy solution. Um, but I did get my glasses finally. I think it's one of the first places that people notice like. If you look tired. Mm-hmm. Or it's an easy place to lose volume as we get older as well. Absolutely. Since the skin is so thin and sensitive and delicate, um. It is very prone to getting irritated.
So allergens either in the environment or in products that you're using on a daily basis that can lead to irritation. Um, also since it's so thin, we see the effects of fluid in that area. So if you suffer from seasonal allergies, for instance, you can see that edema or swelling and that can make you look puffy or you know, just not, well, it just looks.
More like sunken in and dark. Um, in addition you can see congestion at the, the veins and around that area. So, you know, allergies can play a role also with your diet. Eating more salt. I mean, you can look a little more puffier. Mm-hmm. So, um, you can see a lot of different changes because the skin is just so delicate than there.
speaking of the skin, do you wanna kind of go into the different layers of the under eye? So of course the skin is on top. Um, we already mentioned how delicate it is, but um, next we have a couple different layers. Absolutely. So. Eyelet anatomy is complex. Um, there are actually a ton of different structures within a very small amount of tissue.
So you're looking at the skin, obviously as the outer surface. Then you're moving on to subcutaneous fat, and this area has. Very little subcutaneous fat. Mm-hmm. Like we see in other parts of the body. Um, however, we have a muscle right below that, the orbicularis oculi muscle. This is the muscle that's responsible for a lot of the movements around the eyes for like blinking and closing your eyes.
And beneath that is another layer of fat. So that's the orbicularis oculi fat. Also, sometimes we refer this to the sub orbicularis, oculi fat, also known as soup. So that's a cute little acronym for that. Anatomy, which we'll get into a little bit later. And then lastly, below that, fat, we have the orbital bone.
So. A lot of anatomy going on in a very small area. Mm-hmm. Yeah. And as we know, as we age, we start depleting in, you know, our collagen, our elastin production. Um, you'll notice the skin thinning. So especially when that area, when the skin is already so thin, it's going to continue to look a more hollow and more sunken in, um, our fat pads, they can either shrink or even sometimes shift.
So sometimes you'll notice, um, you know, as you get older, almost like those, um. It looks puffy, but it's not actual edema. It's those fat pads. And then even sometimes the bone itself can resorb. So I think there's a lot of different things that happen as we age that contribute to that sunken in kind of appearance.
Yeah. And then I just kind of wanna differentiate that sunken in appearance versus the protuberant, like fat pads. Mm-hmm. So they're totally different problems. Um, you can get those both with aging. However, one is like you're losing. Either fat or getting repositioning of the fat. The other one's like, kinda like fat herniations, the kind of, you know, like projecting out through the muscle and it's kind of protruding and there's different ways that we treat that, which we'll get into a little bit later.
I think there's also a difference too, um, with under eye circles, is it. Hollowing. Mm-hmm. And the light reflection is creating a shadow or is it like hyperpigmentation? Mm-hmm. Or some sort of declaration. Dark circle. Mm-hmm. That's causing the dark circles. 'cause they're treated very differently. Exactly.
And that's why it's so important to be assessed and have a. An examination because it may not be related to volume loss. It may be due to venous congestion or to, um, you know, hyperpigmentation from sun exposure. Mm-hmm. So, and sometimes it's ethnic variation. I mean, there are a lot of ethnicities where these undereye circles are pretty po prominent.
Um, in the South Asian population, for instance. Um, you know, we are very prone to having these undereye circles as a common cosmetic concern. Um, I get them myself and I also treat them. Um, so. You also have to kind of take that into perspective as well when you're doing your treatment plans. Yeah. Why does an Undereye Hollow form, like what are the different, um, anatomical changes that can create an undereye.
Shadow from hollowing. Yeah, so like we had mentioned volume loss or dissension of that soup, that sub auricular, oculi fat pad, um, that can kind of be positioned and kind of makes your eyelid look more hollow. Um, you can also see changes with, you know, swelling, um, with allergies. You can see venous congestion.
So that can kind of give that appearance of that sunken and look. some people can notice like ligament changes. Mm-hmm. So, um, your tear trough ligament, which kind of pulls right here around your eye, um, can become more prominent over time and make that ridge look a little bit more advanced.
Mm-hmm. Yeah, I think there's so many things that kind of go into. Um, the dark circles versus the true hollowing. And I think sometimes patients can even have both and sometimes one will kind of, um, accentuate the other. Mm-hmm. And so I think, again, going back to just making sure you're seeing, um, a professional who knows how to, you know, treat both and differentiate between both.
Um, so you can get the best outcome. Absolutely. So moving on. So how do we treat these under eye circles or hollows? So it goes back to what's causing it, right? So if we understand what's causing the under eye hollowing or the dark circles, we can really, you know, form a good plan that will be effective.
So let's kind of go through some of the treatment options that we have available. First, you know, making sure you're rolling out things. Um. Like any underlying, like eczema, pa, I see eczema patients all the time mm-hmm. Who get that hyperpigmentation underneath the eyes. Mm-hmm. Um, once you've kind of rolled that out, there are some topicals that will utilize, um, retinoids used in definitely more, um, weaker doses than what you might normally use for the rest of the face.
Um. For example, in an eye cream I think typically is a little bit less, um, strong than your just traditional generic Tino that you're getting from the pharmacy. Vitamin C is another great ingredient that can help to brighten, um, and caffeine you'll probably see in a lot of different eye creams. Um, but the caffeine can help reduce some of that puffiness.
Yeah, I really also like peptides. Mm-hmm. Um, I think that they do a great job with this delicate thin tissue to kind of really help. Kind of increase that collagen synthesis. Um, I really love Lumiere. That's what I use from Neocutis. Um, there are a variety of them on the market, but I do think that they pair nicely with, you know, the vitamin Cs, the retinols, um, and kind of giving you that extra, you know, collagen boost, um, to help improve the appearance of your under eye circles by.
Improving the integrity of the skin there. I think it's important to note, I always tell my I always disclose when I'm recommending an eye cream that this is not gonna be a magic eraser for your under eyes. Mm-hmm. Mm-hmm. I think there's only so much that an eye cream can do, and if you're looking for some mild to maybe moderate improvement, you'll get there, but it's not gonna be your fix all. all.
Yeah. And they're not gonna help restore volume, but they can improve the skin quality. And I think. Also lastly, topically, one of the most important things that we can do is protect ourselves from the sun. Mm-hmm. Because the more UV damage we have to the skin, especially around the delicate under eye, the more skin thinning we can get, the more pigment that can show up.
So it, it might accentuate the hollowing a little bit with that skin thinning, but even the pigment is, I think, a separate mm-hmm. Um, entity of under eye aging. Yeah, absolutely. And that's an area that. I will admit that I'm not very good at applying sunscreen. I just kinda like put it on really quickly. I was just about to say that you like said a few episodes back about how you just, because you get it in your mouth.
I remember. So I was like, I don't eat sunscreen, so says the man that wanted to invent edible sunscreen. So I think, but that is so true, where I think sometimes we just rub it on, but we're not really getting right at that lash line. And I know. Dr. Hussein and Heather, I'm sure have seen, um, numerous cancers that actually mm-hmm.
Conform on that eye line. Yeah. Which is my biggest fear. Um, I do, I do most surgery on eyelid skin. I see a ton of basal cells. Yeah. And, you know, those are, you know, very intricate surgeries and it's someplace where you really don't wanna be operate on if you can avoid it. Yeah. Yeah. Um, but there are a lot of great sunscreen products that are especially formulated for the eye.
I love the one that we have in our office. I've been using that and actually that really makes me very conscious of where I'm placing it. I'm making sure that I'm covering it. It's got a universal tint. Makes it look good. And I've been really impressed. Courtney actually made a good choice with that pick.
Yeah. One of many. One of many. 'Cause the under eye circles are a problem for me cosmetically. So hopefully that'll help slow down the aging process. I remember the first time I was like putting on it, it kind of looks like.
I mean, I, I don't really use makeup, so I don't really know what it's supposed to look like. So Amana was watching me putting it on. He's like, are you wearing makeup? I'm like, no, no. This is my new sunscreen. It's a corrector. It's got other ingredients in it too, to help. So she's like, yeah, whatever. Yeah, I, I love that one.
Um, separate of all of that, I did wanna mention, because one of my little like tricks that I'll sometimes tell patients, and this goes back more to like puffiness, but sometimes I'll tell patients just to take like a Zyrtec or an Allegra daily. See if that helps, because you'd be surprised sometimes even people who say, oh, I don't have allergies.
Yeah, we live in North Carolina. I think everyone has allergies. But, um, sometimes you'd be surprised at that puffiness not being correlated with it creates a shadowing effect where you might think, oh, I have dark circles, or I have hollowing or whatnot. But it's actually some of that like edema. Mm-hmm.
And when they take that antihistamine daily, they notice such a difference. So it's such an easy thing to try to see if that helps. And then, you know. That is actually a tip. One of my attendings used to give. She's like, she was a celebrity dermatologist in Washington dc She would tell everyone to take Zyrtec.
Mm-hmm. Um, and it does make a difference. Mm-hmm. Especially if you have subclinical allergies, sometimes you don't really even know you don't have those symptoms. Mm-hmm. And it just really helps you look better. Yeah. And I know like for me, like my allergies were not an issue until it came down here. Yeah.
North Carolina is no joke. Like I was just like, okay, whatever. Boom. Yeah. And then the springtime, like when this, like everything's covered in like this layer of like green. Mm-hmm. Like I have never seen anything this in my life. It's like, it's crazy. Yeah. Yeah. I your under eye or around the eye has a hard time draining lymphatic fluid mm-hmm.
By itself. And so, um, anything in histamines, like Zyrtec can help speed up that process. And we see that even to. Like post procedures, any sort of swelling around the eye is gonna like pool and pocket at the bottom. Mm-hmm. Of the eye. I do also like cool compresses. Mm-hmm. I think that, you know, that causes a little bit of VAs constriction.
It feels nice. It helps with. You know, the drainage. Um, so that's something that can be relaxing, easy to do, low cost. Yeah. And, um, you know, that can improve some of that edema that we see. Sometimes I do have one of those eye mask in my freezer. Mm-hmm. And sometimes just in the morning, if it's really hard for me to wake up, I'll just throw that on.
I think like even the coldness mm-hmm. Helps dep puff, but it also just helps wake me up. I've put a, like a spoon in the freezer and then in the morning I'll take it outta the freezer and just kind of like, place it here. And I guess it's kind of the same thing as, yeah. Cool, compress. So like we mentioned, skincare can only do so much.
I think that we are limited in what we can achieve with skincare alone, so let's move on to some technologies that we can use to help improve our skin under the eyes. So what's your favorite device or technology?
I like radio frequency, but you have to be very careful mm-hmm. With radio frequency around the eyes. Um, do you typically recommend it with microneedling or just on this, you know, like radio frequency? I do. I do like it with microneedling. But you, you don't wanna go too deep because like mm-hmm. Dr.
Zane mentioned that area, even though there's several layers. They're all so tiny and they only Yeah. Um, make up so much volume and depth. So you definitely don't wanna go too deep. You definitely wanna tune it down. Yeah. Yeah. And even just traditional radio frequency can do a nice job with tightening.
Mm-hmm. And, you know, leading to more, um, collagen synthesis. Mm-hmm. An ultrasound too. I've been love in traditional micro. Traditional microneedling with PRP or PRF. Mm-hmm. That's been I think, such a game changer for a lot of patients. Yeah. Who get a little nervous. I think it's a good segue. Treatment without being, um, too scary.
It's so tolerable. Yeah. Yeah. I think people are worried mm-hmm. That it's so close to the eye that it'll be painful or that it'll go too deep or these things. When you're seeing a professional, I mean, I get right up to the lash line Yeah. On my patients. Mm-hmm. Um, it's very doable and it helps a lot. Yeah.
And that's like virtually painless. Mm-hmm. Mm-hmm. And you get great results with it. And you know, for most patients, you know, if you can, you know, just improve the under eye area with a microneedling, you can also like improve the rest of their skin on their face. And it just really gives you that beautiful glow and you get nice rejuvenation.
Mm-hmm. I'm also a big fan of non-ablative fractional lasers. Mm-hmm. I love using this similarly to like microneedling, it's creating little micro channels using thermal heat and light, but it's also causing tightening and contraction. I really like that. Um. We recently did some non-ablative. Yeah, fractional resurfacing.
You guys might have saw my eyes during our Gallant Times's episode where I told you to love yourself and here I was. Um, you never mentioned it, I don't think. I know I tried to ly put it in there, but I'm sure like if people are watching, they're like, did you look like a train wreck? She wasn't aware.
Wear, she was gonna wear sunglasses. But then I Oh, you put. Tinted sunscreen. I something. Yeah, it covered it pretty nicely. It covered Okay. I was still puffy. Yeah. I applaud you for going on camera. And I just wanna say Heather had a patient today that even had numbing and it was on the chin, and she said.
It hurt and I had no numbing. So I wanna applaud myself for sticking through it. Yeah, I mean, especially around the eyes. Um, I had another patient who had no numbing and we were just treating a scar and she took it like a champ. I'd recommend numbing. Um, but I think that extra heat causes tissue contraction.
I love that for the eyes. Um, and then if you really wanna kind of go for the gold, I think CO2 fractional laser mm-hmm. Is phenomenal. Mm-hmm. Nothing gets a response like that, that's outside of surgery. Mm-hmm. And we see some beautiful results with that. If you're willing to have the metal shield in your eye too, you know, we can get all the way up to the lash line, which is nice.
Yeah. You don't. Mind the medieval look of metal in your eye? It's not bad when it sits in. Yeah. Once it's in, yeah, that's what she said. So what about chemical peels? What are your thoughts on those? Um, I think peels can help more so I find with discoloration yes. Than with true a true hollowing. Um, that being said, you do again, just wanna make sure the person that is treating you knows what they're doing.
Typically, when I'm doing a chemical peel on a patient. I, I would say always treat underneath the eye. I'll normally do a layer, a light layer last. Um, you wanna be especially careful because you do obviously do not wanna get any acid in the eye. So making sure you kind of squeeze out the gauze and you get that light layer.
But I do think it helps, um, more again, with the discoloration rather than true and fine lines and fine lines. Tiny texture. Yeah. We did the rev peel on Heather's mom, um, a couple months ago now. How did you do. Good. Yeah. Yeah. She liked the results. Yeah. It helped a lot with those fine lines. Mm-hmm. And that's a more intense peel, so you can do.
Upwards of a TCA 30 or, you know, around, around the eyes. But again, you just wanna be really careful and make sure you're really subtly treating that area. Yeah. Honestly, I try to stay like at 10%. Um, I don't really like going up higher just for those theoretical risks, and you can get some nice improvements even with serial mm-hmm.
Treatments. Mm-hmm. Um, so I try to be safe around the eyes. Yeah. Yeah. Yeah. Um, all right, so let's go on to some more aggressive treatments or a little bit more invasive. So. In terms of the hollows, we're looking to restore volume, right? So we need to replace volume with volume. So what are we gonna use? So we have a few tools at our disposal.
So fillers, like specifically hyaluronic acid fillers, have been a mainstay of treatment for a long time, and we get some really great results with it. Mm-hmm. If you inject properly, yeah. So the problem with HA filler is if you inject in the wrong plane, the results can look awful. Mm-hmm. Mm-hmm. And you definitely have seen people, I'm sure who have had bad work, and you can spot it from a mile away.
They look puffy. They kind of have this bluish tinge to their skin. If they look, I think a little deformed. Mm-hmm. Um, it does not look normal. And you really have to, um, respect the anatomy. Like we said, we focused on the anatomy 'cause it's so delicate. You want to make sure that you know, you are treating the anatomy with respect.
Now, first and foremost, when I'm injecting hyaluronic acid filler, I'm first addressing the volume loss in the mid cheek. That is really where you want to kind of create that support, that foundation, because that, you know, medial fat pad is kind of where we see that atrophy, that shrinking and that hollowing effect really take place.
So if we volumize that you create a nice support for the tear trs and just by that alone, by restoring the volume there, you can like improve the tear TRS by like. Sometimes 50, 75% just with volumizing, that area. Once you volumize that area, then you can kind of really go to that, you know, natural transition between the eyelid skin and the cheek skin and kind of create that more, that natural transition.
Very delicate. And you're injecting on bone. So a lot of people think that you're just injecting in the skin, you know, in the dermal space like you do in other um, areas. But no, you are literally injecting on bone I feel for bone. Mm-hmm. And that is the proper plane to inject in. When I'm injecting, I'm also using a cannula.
So this is a blunt tip needle that um, you know, we introduced through a small insertion site with an introducer needle, and we're basically using that as a way to inject the filler. Without harming any of that tissue, so it's not sharp. So it just moves blood vessels and nerves and you know, other tissue out of the way and we're able to inject.
So it minimizes your risk of bruising because there's so much vasculature around the eyes mm-hmm. That when you bruise, you bruise. Mm-hmm. And it's a pretty bad bruise, and it takes a while for that to dissipate. So that's been a game changer when I transitioned from needle to um, cannula, especially for the tear trough area.
I think, um, across the board, if filler, especially hyaluronic acid filler is placed incorrectly anywhere on the face, it can look odd, but because there's so many subtle changes that can be noticeable under the eye, if filler is placed incorrectly. Everybody will mm-hmm. Know, they might not know exactly what happened.
Yeah. But you'll, you know, it definitely looks odd. Yeah. And sometimes when you have too much there, also, there's a lot of swelling involved with mm-hmm. You know, hyaluronic acid fillers. So you just wanna be mindful of that. And if you have too much, especially if you have allergies like simultaneously, it can look really puffy.
Yeah. You definitely don't want to go to somebody who's. Um, a beginner injector and mm-hmm. Trying to do the under ic, it's a very complicated area. Yeah. And takes a lot of training and skill to do it right? Yeah. I think the one benefit of filler truly is, um, the speed in which mm-hmm. Instant, instant gratification.
Yeah. Um, whereas some of these other procedures obviously do take time. It is your own natural collagen, but the filler. If you're looking for something that is a lot quicker, if you have an event coming up or whatnot, you might wanna consider, absolutely. It could be game changing. I mean, I had a patient this week.
He's this 39-year-old guy, always self-conscious about his under eye circles. He's had him since he was young and he just always looked tired. And, you know, we did some hyaluronic acid, um, you know, injections under the eyes. And literally after he saw the mirror, he started crying because for the first time, like he felt like he looked like himself, he didn.
Tired. And, um, it was a response that I wasn't pathetic. I thought when he started crying I was like, oh my God, he doesn't like it. Thank me. I'm like, okay. But yeah, it can be pretty. Um, big game changer. And I've had filler done under my eyes and the tear troughs and, you know, have had good results with it.
Um, I do. Like kind of mixing around some of the technologies as well. And I've been recently doing, um, PRF, which we'll get into and, you know, all these have their pros and cons, but filler is a really good option for the right patient. Mm-hmm. Mm-hmm. Not every patient's a good patient for it, but, um, you know, if you are looking for that instant gratification, if you're looking for longer lasting, um, results too.
I mean, filler you can get like year to two years. Um, have really nice results with it. I think I see a lot, or maybe a decent amount of people who want under eye filler, um, but they have that protrusion. Mm-hmm. And they think that the under eye filler is going to resolve that, but really they need either.
Yeah. You know, that. Replacement or less. Yeah. Need a blood plasty at that point. Yeah. Get into as repositioning. I mean, that's a no fly zone if you're seeing those like bags on your eyes, if you see those festoons, anything like that. I mean, you wanna stay away from filler because it's just gonna look worse.
Yeah. With more swelling, it's gonna accentuate it. Yeah. So let's get into some of the biostimulatory, which I'm excited to talk about because I had filler, or I'm sorry, I had, um, sculpture. Sculpture about what, a month or two ago now. Mm-hmm. And one of my concerns definitely, as probably most people have is their under eyes, and we treated mostly my cheeks.
Um, but I still saw nice results even. Mm-hmm. With that, I mean. I don't know if it's because of the massaging and it, the, that sculpture kind of getting to those areas, but I saw a really nice result pretty shortly after. Mm-hmm. The sculpture, um, with my under eyes. Yeah. And I'm liking it and I mean, I read a paper that, you know, we are seeing improvement under the eyes with these biostimulatory fillers, and I do think that it gives a more natural look.
Mm-hmm. And it's easier to place properly. Than filler. Mm-hmm. So, I mean, you know, if you're going to go to someone who is less experienced or has not done a lot of injections, I mean, s Sculptra, if you're injecting the right plane, that's a pretty straightforward injection. Mm-hmm. Yeah. Um, PRF, um, is what we had talked about earlier.
Um, I think I'm the only one at this table that's not had PRF, so maybe that should get on the book. No. So maybe that should be on the book soon so I can truly do it with numbing. Oh yes. Do it with numbing. Um, do it with pron. Um, but we're basically using your plasma, um, as we've talked about in previous episodes.
Yeah. And injecting it into that area, almost like a filler. So we use a gel like consistency. We're actually taking your plasma and heating it up essentially, so it becomes this gel, almost filler type. Um. Method. So we're going in filling that area and I think people are getting nice results and nice natural results where you don't have to worry about filler.
The, the placement, I would say as much. Mm-hmm. Your body is able to absorb and kind of use those growth factors stimulate its own collagen and you don't have that same risk of placement. Mm-hmm. And it does have a slight, you know, volumizing effect. Temporarily. Mm-hmm. Um, so I do think that you do see some of the results of that, but I think it's really the long game that you're looking at.
And typically we repeat these treatments more than once, and we're trying to really build some of that tissue, that collagen and just kind of get that improvement. And I see some nice improvement also in the, you know, just the brightness mm-hmm. Um, in that area. So, um, I've been pretty impressed with it, but it is a little bit of a slo a slower process than we do see with other mm-hmm.
You know, treatments like filler. Mm-hmm. All right, so let's go on to some surgical options. Obviously this area is a very delicate area and you know, anything that, you know, like we talked about those protuberant, um, fat pads under the eyes. I mean, that is a surgical case and you know, I would definitely seek the treatment with an oculoplastic surgeon to do a lower eyelid blepharoplasty.
They are able to, you know, go in there, um, really reposition that herniated fat and make it look much more cohesive and smooth. Um, and it can be a game changer. And you know, the oculoplastic surgeons are ophthalmologists who have an additional fellowship training in plastic surgery around the eye, and they know the anatomy inside and out.
And that's who I would refer my patients to, to get an excellent job. And you know, I had some training in residency, but it is very intricate and there's some structures that I just don't have the tools and the right equipment. And if, God forbid we have a complication, you know, I don't feel comfortable like being able to fix it.
So that's why I kind of refer those out, um, just to give the patient the best possible care. Yeah. And you have to be careful with fat transfers too, because we were talking about this earlier that, um, if it's placed two superficially mm-hmm. It's gonna be easily noticeable. Um, I had a colleague I was working with who had a fat transfer and one of her under eyes was placed two superficially.
And yeah, you could easily tell, and it's very unfortunate because, you know, you spend so much money and mm-hmm. Hopefully you're going to somebody who's very experienced with it, but, , it's right on the front of your face too. So, I mean, it is a technique that's been used for a long time and you can get beautiful results.
The problem I have with Fat Transfer is you're. Basically using a biologically active tissue, right? Mm-hmm. And it all has metabolism in placement and you don't know how much it's gonna take. Um, it can be asymmetric. I've seen, you know, patients where like they had asymmetric, um, volume loss of the fat pad, so it just didn't look even and you couldn't do anything about it.
I had another patient who went overseas for a fat transfer and. She developed this granulomatous reaction to all the fat. So her face was like literally like turning puffy everywhere. Mm-hmm. You can see like little nodules forming wherever she had like fat placed. Oh my gosh. And you know, like things can happen like that and you know, you just have to be very careful.
Yeah. Yeah. Um, so we talked about a lot of the treatment options for the lower eyelid, um, and the under eye halls. I just wanna spend a little bit of time on the upper eyelid. I know that wasn't the biggest focus of this podcast, but I think it's worth the mention because we see a lot of patients who are concerned about, you know, hooding of their upper eyelids looking droopy, can't really see properly.
Oh, please. Also, we're so in sync because I was also just about to bring that up. Yeah. Um, great minds think alike, right? Yeah. So, um, you know, with aging, um, sun damage and, you know, your skin just loses laxity as collagen and elastin, you know, tend to degrade. You get hooding and you have probably seen patients, especially elderly patients, where there's excess eyelid skin and sometimes it can impair vision.
And you know, it's a relatively easy treatment, um, where you cut the, um, excess. Skin, but you have to be very precise. Mm-hmm. And you want to measure, make sure that you have the anatomical markings and really, you know, excise the right amount of tissue. 'cause that's key. 'cause if you take too much, that can be a problem.
Mm-hmm. Um, but you can get some beautiful results. I had, um. A blepharoplasty patient today who came back for followup, I think we did like two or three months ago. Looks beautiful. Um, she's very happy with the results, but you know, you just have to be very careful about, you know, how to do that surgery.
And if they have ptosis, you know, there's other, you know, techniques that you have to use to help address that. So it can be subtle. Um, you know, for straightforward cases, I think, you know, a good cosmetic surgeon, a dermatologist, um, an oculoplastic surgeon. But if it's something more complex, I send those to oculoplastics as well.
Yeah, my dad had a blepharoplasty, upper blepharoplasty. His was covered by insurance. It was impairing his vision and it went really smoothly. He said he would do it again in a heartbeat. Um. He looked like a Hannibal Lecter for a week. 'cause you have your stitches in there and there're teeny tiny stitches.
And there's usually about, I don't know, like eight to 10. So, and you bruise obviously. Um, but once that whole course is finished, I mean, the results are remarkable, I think. So it can make a big difference. You can look decades younger, um, despite addressing that eyelid skin. What do you think about Botox?
I, I feel like we get a lot of patients that ask, oh, well, can I do a little like brow lift? Will that help with the hooding? If I put some tox? It can only do so much. Yeah. Um, and if you have, you know, really a lot of, you know, dramatic oasis, I don't think that you'll get that result that you need, especially if it's impairing your vision.
I mean, yeah, that's surgical in my opinion. Um, but you can get like a nice, you know, brow lift, a chemical brow lift. Um, you can also treat the crow's feet, the cul oculi muscle under like the jelly rolls, um, to just kind of help improve, you know, the appearance. But you have to be. Careful. You have to make sure that they have enough skin integrity.
Um, I do like the snap test to make sure that, you know, they have enough tension and mm-hmm. It's not gonna lead to something called atropin and it just kind of droops. Mm-hmm. Yeah. Yeah. All right. So that's our upper eyelid discussion and in summary, you know, we. Looked at the various causes of under eye issues such as hollowing, um, hyperpigmentation, um, also protrusion.
And I think it goes to show you that you really have to assess your patient carefully to really address and understand what's causing the issue that they're coming in for and properly treating it. And patients should have a customized approach. Not every patient is coming in for the same problem, and I know that there are places that use the same methods for every patient, and that's not.
Doing a ser a service to your patient, we really may need to find out what's going on and properly address it. Mm-hmm. Mm-hmm. Um, so, you know, the under eye area is a very common area of insecurity for patients. Um, I've dealt with it. I think many of us have dealt with it. And there are things that you can do.
You don't have to suffer in silence. You can seek the guidance, you know, if you're board certified dermatologist, um, your oculoplastic surgeon, plastic surgeon. And there are things that you can do to really help improve and restore your confidence. So I definitely encourage you to seek, seek out expertise if you need it.
Um, but you know, I think that. We can do a lot, um, you know, non-invasively these days, and that's a really nice thing to be able to offer, especially patients who are worried about surgery. Yeah. Mm-hmm. I was gonna say, there's a lot of different options for different comfort levels, so. Mm-hmm. I think that is incredibly helpful.
Yeah. Yeah. All right, well I think this was an enlightening discussion. A very common issue that we deal with the underlying hollows and hopefully this, um, gave you some insight on some of the treatment options you have available. Um, so until next time, skin side out,
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