Step 1
The youthful appearance of the eye requires a smooth transition between the lower eyelid and the upper cheek. This transition zone is known as the tear trough. Age-related hollowing in this region can create unsightly eye bags. These are often made worse by skin laxity in the lower eyelid and puffiness due to fluid retention.
Below, there are photos of a lady treated with 1ml of filler into her cheek and 0.3ml of filler into her tear trough on either side. The combination treatment resulted in a well rested and rejuvenated look.
Before (left) and after (right) dermal filler (frontal view).
Before (left) and after (right) dermal filler (oblique view).
In animation (squinting), marked improvement of the wrinkles around the eyes can be seen after treatment. This is due to the hydrophilic (water absorbing) nature of the hyaluronic acid filler which has a plumping and hydrating effect. The effect is similar to the smoothening of a ballon's wrinkled surface when inflated.
Before (left) and after (right) dermal filler in animation (squinting).
Step 2
The second step was injecting 20 units of Botox into the frowning muscles (procerus and corrugators). As these muscles are also responsible for pulling the eyebrows down, relaxing them gives the eyebrows a lift and enhances the eyebrow arch.
Before (left) and after (right) Botox.
This is an example of how a combination of two relatively inexpensive injectable treatments, can produce results comparable to an expensive and invasive surgical treatment such as blepharoplasty.
References:
1. De Maio M, Rzany B. Injectable fillers in aesthetic medicine. Injectable Fillers in Aesthetic Medicine. 2014.
2. Carruthers J, Carruthers A (2004) Aesthetic botulinum A toxin in the mid and lower face and neck. Dermatol Surg 29(5):468–476
3. Carruthers A, Carruthers J, Monheit GD, Davis PG,Tardie G (2010) Multicenter, randomized,parallel- group study of the safety and effectiveness ofonabotulinumtoxinA and hyaluronic acid dermal fillers(24-mg/ml smooth, cohesive gel) alone and in combination for lower facial rejuvenation. Dermatol Surg 36(Suppl 4):2121–2134
4. de Maio M (2003) Botulinum toxin in association with other rejuvenation methods. J Cosmet Laser Ther 5(3–4):210–212
5. de Maio M (2004) The minimal approach: an innovation in facial cosmetic procedures. Aesthetic Plast Surg 28(5):295–300
6. Schierle CF, Casas LA (2011) Nonsurgical rejuvenation of the aging face with injectable poly-L-lactic acid for restoration of soft tissue volume. Aesthet Surg J 31(1):95–109