Question:
I am scheduled for erbium laser resurfacing on lower eyelids in two months. If I wanted to get filler done under the eyes should this wait until after the resurfacing? Or how long after resurfacing would you recommend getting the filler injected if it can be done at all?
Answer:
It probably makes the most sense to first undergo the erbium laser resurfacing. Most likely you are considering injection of a filler to help fill in the tear trough between the lower eyelid and the nose. The erbium laser resurfacing will help smooth the wrinkles on the lower eyelid and may result in some improvement in the tear trough. Because there is some tightening of skin resulting from the erbium laser resurfacing, you may see modest improvement in the tear trough, which would enable the use of less filler.
The standard fillers including Restylane, Juvederm and Radiesse can be used to improve the tear trough but must be used with caution to avoid a visible lump or discoloration of the treated area. These fillers are usually placed deep beneath the skin, just above the bone. The results are temporary.
The best filler for the periorbital area, including the lower eyelid, is autologous fat. Fat is the only substance that can be evenly distributed throughout this area (it should be placed beneath the orbicularis muscle) and is also the only filler that gives permanent improvement. Fat grafting in the periorbital area is an advanced technique that must be done with care in this delicate area. Restoring lost volume in this area re-creates a youthful appearance and also reduces wrinkles because the skin has greater volume beneath it.