Ideal anatomy and proportions:
A young eye is defined by an eyebrow in an ideal position to the eyebrow lift, a deep and well-defined upper crease that does not come into contact with the eyelashes distance from crease to eyelashes: 8-10 mm, distance from upper crease to eyebrow: 12-16 mm), and a smooth lower eyelid without hollows or bags. The orientation of the eye canthal tilt canthopexy should be neutral or slightly rising towards the temples (lateral canthus 1-2 mm above medial canthus).
Puffy lower eyelids is often due to excess of the fat loges (fatty degeneration that occurs over time): there are 3 fat lodges at the lower level. When the lower eyelid presents an hypertrophy of these fat lodges, the result will be optimal with a lower blepharoplasty.
When the lower eyelid is hollow, there is a good indication for filling with hyaluronic acid or fat (=lipofilling).
Technique :
Hyaluronic acid: entry point (<1 mm at the cheek), then filling in 2 planes: one deep between the bony border and under the orbicularis muscle and the other, minimal, beetween the orbicularis muscle and the skin, all with an adapted hyaluronic acid, specific for the eye area. In general, 1 ml for both sides is sufficient for moderately marked temples.
Lipofilling: fat removal (often inner knee or abdomen) under local anesthesia (no pain with an adapted anesthesia), decantation and specific preparation of the fat (purified fat, rich in stem cells) and then reinjection by the same technique as hyaluronic acid.
Results :
Time to final results:
Hyaluronic acid: immediate
Lipofilling: 1 week for the filling, but 3 months for the rejuvenation effect on the skin of the stem cells contained in the fat
Longevity of results :
Hyaluronic acid: 6-12 months
Lipofilling: 5-10 years
Before injection:
Stop smoking 1 month before lipofilling
Do not take Aspirin 10 days before surgery, inform Dr. Lucas of any anticoagulant medication (Sintrom, Coumadin, Eliquis, etc.) to arrange for its discontinuation or replacement.
Take Arnica capsules 5 times a day for 5 days before surgery to prevent hematoma.
Contraindications hyaluronic acid: autoimmune diseases, pregnancy, breastfeeding
Procedure :
Pain: the pain during the intervention will be almost non-existent, with an adapted anesthesia
Duration of the procedure: 20 minutes for hyaluronic acid, 40 minutes for lipofilling
Anesthesia: local
Location: office for hyaluronic acid, operating room for lipofilling
Ambulatory (without hospitalization)
After injection:
Post-operative pain: 1/10 often responding to Dafalgan
Social eviction:
Hyaluronic acid: no (discrete swelling for 24-48h)
Lipofilling: swelling and hematoma for 4-7 days
Sutures removal: no sutures
Return to work: immediate for hyaluronic acid, 2-3 days for lipofilling
Return to sports: 24 hours for hyaluronic acid, 2-3 days for lipofilling
Instructions:
Bed rest without major effort and ice mask for 24 hours, as often as possible, to reduce swelling.
Do not compress the fat injection area if lipofilling (risk of fat loss)
Take Arnica capsules 5 times a day for 5 days after surgery to prevent hematoma
Stop smoking permanently to prevent fat and hyaluronic acid resorption
Hyaluronic acid:
Control Dr Lucas 2 weeks
Lipofilling :
Control Dr Lucas 2 weeks, 3 months
Complications:
- Infection, hematoma, asymmetry, under or overcorrection
- Intravascular emboli: it is important to have this procedure performed by a qualified physician who is used to injecting this area, which is richly vascularized with a very variable vessel anatomy. A vascular embolus if it moves in the circulation of the retina can lead to blindness or necrosis.
- Tyndall effect: bluish coloring related to the visibility by transparency of a product injected slightly superficially under thin skin (can be corrected by hyaluronidase)
Alternatives and operations that can be combined:
Global rejuvenation of the eye: this operation can be combined with blepharoplasty, a filling of the hollow temples or a brow lift.
