As we age, we lose volume in certain parts of our face while we gain volume in other parts. Generally speaking, the region around our eyes and cheeks begins to lose fat, while the jowls and neck begins to gainfat. This progression has little to do with your body weight. The fat stores in the upper cheek and around the eyes are genetically predisposed to volume loss.
Eye Rejuvenation may be one of the highest impact methods of facial rejuvenation. Traditional approaches focus on blepharoplasty or eyelid surgery in which skin, muscle and fat are removed in order to sculpt the eyes. The reality is many times the eyes would actually look older and often just different. This misses the whole goal of eyelid surgery which is to make the eyes look refreshed and revitalized.
Adding volume is the most effective way of rejuvenating the eyes. The real advantage is that it is non-surgical and highly effective. My first choice for treating the hollows under the eyes is Restylane or Juvederm for mild changes in a younger patient. This technique is used to fill the tear troughs. In patients with more advanced volume loss that extends into the upper cheek region, and beyond the tear troughs, fat transfer is an excellent long-term solution. Fat transfer works by restoring the shape and contour of the midface and cheeks. This gives the upper face a much younger appearance without making the person look different. Another advantage of fat transfer is that the results are permanent.
Sculptra is an excellent alternative to fat transfer. I use it frequently to treat volume loss throughout the face. The one area that needs the most experience and technical precision is under the eyes. Treating this region can result in difficult-to-treat nodules and contour problems. However, if the individual has had experience and success with this area and is aware of the different dilutions and technical issues involved, then Sculptra may be used. Unlike a standard filler, Sculptra works by stimulating fibroblasts in the skin to increase collagen growth. This results in thicker skin which enhances volume. The results are long-lasting (> 2 years).