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Ask Dr. Rivkin questions on all non-surgical cosmetic procedures, laser treatments, and injection fillers, including Botox, Juvederm, Restylane, Radiesss, Sculptra, IPL, Fraxel, Thermage, Mesotherapy, Non-surgical nose job, chin/cheek augmentation, and many other procedures.
There are usually four components that make up the appearance of puffy and tired looking eyes.
1. Dark pigmentation of the skin under the eyes - usually genetic.
* Treatment option: Not a lot that can be done about dark circles. Bleaching creams with hydroquinone or kojic acid sometimes help.
2. Fine lines and wrinkles throughout the lower and upper lids - "crepey" skin.
* Treatment option: The only really effective solution to this issue is laser treatment. Certainly moisturizing and Retin A help, but the effects are slow.
* The only laser that I have seen that actually makes any difference in under eye wrinkles is the Active Fx/Deep Fx. The treatment is quick and relatively easy, with about 4 days of downtime and a week of redness that can be covered up with make-up. Results are dramatic.
3. Bulging of the skin under the eyes caused by fat tissue that is "pooching" out.
* Treatment option: This is usually a surgical issue. If there is a large amount of bulging, only blepharoplasty with fat repositioning will really help.
* However, if there is only a small to moderate amount of bulge, I usually use Juvederm under the bulge to camouflage the appearance. If you raise the skin under the bulge with a filler like Juvederm, filling in the valley underneath the bulge, the observer no longer sees the bulge. It's a bit tough to explain - I have lots of examples on my website.
4. "Tear trough" under eye area indentation - caused by loss of volume with age in people that are genetically prone to having this problem.
* A shadow falls into the indentation, causing the dark circles that give a tired appearance. Loose upper eyelid tissue that overhangs the eyelid is another element in making the eyes look tired, but we're concentrating here on the lower eyelids.
* Treatment option: This is the situation that is most common in my practice. Time and genetic predisposition cause an indentation in the "naso-jugal groove" (the area underneath the lower eyelid), a shadow falls into the groove and the person's eyes appear tired. This is easily corrected with a hyaluronic acid filler.
* I prefer Juvederm because it is smooth and lasts for over 1.5 years in that area. This is a technically difficult procedure and should be done by experienced injectors only, so if you're thinking of having this procedure done, you should certainly find out how many the doctor has performed.
* Aside from filler there lasting 3 times as long as any other area, the other unique quality to the under-eye area is that it is pretty much painless. The skin doesn't seem to have alot of pain nerve connections.
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