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Juvederm for Upper Eyelid Contour Irregularity

September 2, 2008
Hi Dr. Rivkin,

I have a higher crease and some fat loss in one upper eyelid after granuloma and suture cyst removal. I have been told it would be easy to correct with a filler such as restylane. What filler do you prefer for the upper eyelids?

My main hesitation is that I am concerned about safety. If I inject the eye with temporary fillers every 6 months or so, I may have some bad luck one day where the filler occludes the retinal artery. I have read this happens once in a great while when lids are injected with an anesthetic agent prior to surgery. Do you think this is a possibility, albeit remote, with with filler injections?

I have also thought of a fat graft rather than fat or other injections, as that would be a one-time operation, but I hear fat grafts do not always retain well. Thank you for any feedback on these issues.


hi,
the concerns that you raise are certainly valid.
first off, i prefer juvederm for the upper eye area - it is smoother than restylane. second, these fillers last considerably longer than 6 months in the eye area. when i inject the lower eyelid crease with juvederm, it usually lasts for a year and a half or more. so, i wouldn't worry too much about repeated injections - the filler stimulates collagen growth and so you may only need a few sessions to achieve fairly permanent results.
i would definitely never use any other filler aside from restylane or juvederm around the eyes.
lastly, you should go to a physician very experienced in filler injection first and injecting around the eyes second. just because someone is an opthamologist or an oculoplastic specialist does not mean that they are an experienced injector. don't be shy to ask specific questions.
i don't like fat that much, although i have seen good results with fat grafting. sometimes fat lasts for a long time, sometimes it lasts for 6 months. filler is so much easier that i do not see any reason to use fat.
in terms of artery embolism, i have injected about 700 patients under the eyes so far. i have never seen a problem and i do not expect to. i would not worry about it. the risk is very remote.

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