Sahand Hoseini for Unsplash - Under-eye Filler

sahand-hoseini-RnCLtXEouJE-unsplash-min (1)-min

You’ve likely seen the before and after pictures on social media of people who seemingly had all of their under eye concerns erased thanks to a bit of strategically placed filler in the tear trough region. For the right patient, under eye filler can have a transformative contouring, smoothing, and brightening effect. But depending on the cause of your dark circles, hollowing, and skin quality concerns, under eye filler can actually make matters worse.

So, how can you tell if you are a candidate for under eye filler? We’re talking to top dermatologists and plastic surgeons about the pros and cons of the minimally invasive procedure and the factors that go into determining whether or not it’s right for you.
## **The Benefits of Under Eye Filler**
When we talk about under eye concerns, it's often in general terms. How many times have you heard someone say their eyes look 'tired'? Or that they want them to appear more ‘awake’? The reality is that there are a number of smaller factors that contribute to the eye area looking a little sleepy. 

One of the biggest culprits of 'tired' under eyes is a lack of volume in the under eye area either due to anatomy or age. “In some patients, aging leads to the loss of fat under the eyes, giving a hollow or skeletal appearance,” says [Nigar N. Ahmedli, MD,](https://www.montefiore.org/doctors/profiles/1790164341/nigar-n.-ahmedli) a board certified otolaryngologist in New York City who specializes in facial plastic and reconstructive surgery. Those hollows can then create the illusion of darkness in the region. "They worsen the appearance of dark circles under the eyes by creating a shadow that accentuates the darkness," she notes.

Additionally, the volume loss draws attention to the tear trough. “The ‘tear trough’ area refers to the separation between the lower eyelid and the upper cheek,” says [Elizabeth Callahan, MD,](https://sarasotadermatologist.com/) board certified dermatologic surgeon in Sarasota, FL. Coupled with changes in skin quality, the result is fine lines, dark circles, a general loss of contour, and, yes, an overall 'tired' appearance. 

Injecting a hyaluronic acid (HA)-based filler into the under eye area can be an effective treatment for this. “Under eye filler is best for providing volume to the hollows beneath your eyes,” says [Melissa Doft, MD,](https://aedit.com/provider/melissa-doft-md-63) a double board certified plastic and reconstructive surgeon in NYC. "Adding filler to the under eye area will help with shadows and also act as a wonderful moisturizer to help with dehydrated and crepey skin."

It can also be used to improve the contour of the upper face. "Under eye fillers can address the hollows created beneath the eyelid and at the junction of the cheek and lower eyelid," says [Kenrick Spence, MD,](https://www.mynewbeauty.com) a board certified plastic and reconstructive surgeon in Orlando, FL. "Asymmetry can be corrected and dark circles can be softened with the help of under eye fillers."

## **The Misconceptions About Under Eye Filler**

Here’s the thing, under eye filler “can address aesthetic concerns like hollowness, volume loss, and shadows,” says [Kami Parsa, MD,](https://www.oculoplastic.info/) a board certified oculoplastic surgeon in Beverly Hills. And here comes the ‘but.’ “A misconception is that filler can help everyone,” Dr. Callahan notes. This is because “under eye filler is not a blanket intervention that addresses all under eye-related concerns,” Dr. Ahmedli adds.

With that in mind, we asked our pros to break down some of the most common misconceptions about under eye filler:
### **1. Under Eye Filler Treats Eye Bags**
For starters, under eye filler does not treat what we colloquially refer to as ‘eye bags’ and puffiness. “Puffiness is due to excess fat or lack of proper lymphatic drainage,” Dr. Doft says. “Both of which will not improve with fillers.” Regardless of the cause, the appearance of puffiness is “the opposite of having hollows,” Dr. Ahmedli notes. 

In the case of puffiness caused by excess fat, “the under-eye fat protrudes forward instead of retracting into the eye socket,” Dr. Ahmedli explains. Filler will only exacerbate this. “Adding filler to an area that’s already puffy just makes it worse,” Dr. Parsa says. This can be true even if you simultaneously have both depressions and puffiness as a result of displaced fat. “In some people, there are under eye bags, which create a relative bulge followed by a hollow,” says [Lesley Rabach, MD,](https://lmmedicalnyc.com/dr-lesley-rabach/) a double board certified facial plastic and reconstructive surgeon in NYC.
### **2. Under Eye Filler Erases Dark Circles**
You’ll be hard pressed to find someone who hasn’t dealt with dark circles under the eye. And while under eye filler can help brighten the area by lessening the shadowing caused by hollowing, it does not directly treat discoloration. “Filler will not improve dark circles or discoloration of the skin,” says [Oren Tepper, MD,](https://orenteppermd.com/) a board certified plastic and reconstructive surgeon in NYC. 


The reason? Dark circles are not one size fits all. “Dark circles and hollows under the eyes can be caused by various factors, including lack of sleep, genetics, aging, allergies, sun exposure, dehydration, various lifestyle factors, and other medical conditions,” Dr. Callahan shares. And remember: “Everyone has some degree of darkness under the eye,” Dr. Rabach emphasizes.
### **3. Under Eye Filler Is Risk Free**
Getting HA filler in any part of the face can seem like a ‘quick fix’ that offers immediate results with little to no downtime. But the reality is that injecting filler – especially to the complex under eye area – requires a great deal of training and understanding of facial anatomy. “There is a misconception that placing filler under the eye is completely safe,” Dr. Doft cautions. 

As she explains, under eye filler can have a tyndall effect when it’s injected too superficially, leading to a blue tint under the skin. It can also cause “scarring of the lymphatics leading to malar bags and possible blindness,” she says. For these reasons, “this is a procedure I would only have a board certified plastic surgeon or dermatologist perform,” Dr. Doft shares. 

Technique is also vital to ensure a safe, effective, and aesthetically pleasing result. “Many providers place tear trough or under eye filler in the wrong spot,” Dr. Rabach notes. “It is a very delicate area, but it is most of the time placed too low – almost over the orbital rim – instead of high into the tear trough.” Seeing a board certified provider who regularly performs the procedure can help mitigate this risk.
### **4. Under Eye Filler Is Like a Filter**
Even in the best hands, it’s also important to keep your expectations in check. “The most common misconceptions about under eye filler are that it is a simple intervention that improves under eye hollows, bags, dark circles, and skin texture,” Dr. Ahmedli explains. “It is crucial to understand that dark circles are due to the deposition of pigment into the thin skin of the eyelid, and lower eyelid skin tends to become like crepe paper – crinkled with fine lines – with aging.” 

And no, you are not going to look perpetually Facetuned. “People think under eye filler will completely make under eye hollows or darkness go away, and that you will look like a heavily filtered Instagram model after treatment,” Dr. Rabach says. “No one looks like this.”
## **Are You a Candidate for Under Eye Filler?**
Now that you know the benefits and limitations of under eye filler, it’s time to determine if you are a candidate. During a consultation with a board certified dermatologist or plastic surgeon, the provider will be studying the under eye region to determine the root cause of your aesthetic concerns. "There are so many factors when we discuss the under eye hollows because they happen for so many reasons," Dr. Rabach notes.

As she explains, it is important to look at skin tone and what is behind any darkness or discoloration. “The skin is so thin, so we can see tiny blood vessels under the skin,” she shares. “The skin is also more prone to pigmentation due to the hollow and being so delicate.” Additionally, darkening under the eyes can be caused by “light reflecting off the concavity making a shadow,” she notes. Only the latter can be improved with filler.

And then there is the contour of the under eye region. “In some people, there are under eye ‘bags’ that create a relative bulge followed by a hollow,” she says. “We also need to consider the relationship and general anatomy of where the orbital rim is related to the eyelashes and the direction of the hollow.” These factors and more, she notes, “need to be weighed for candidacy for under eye filler.”

Here are some general guidelines for what makes someone an ideal candidate for under eye filler:
### **Ideal Candidates for Under Eye Filler**
The ideal candidate for under eye filler “is a patient who has hollows under the eyes without puffiness and without heavy dark circles,” Dr. Ahmedli says. “This allows for filler to be placed in the hollow to correct the depression and to restore the natural slope of the under eye-to-cheek transition found in a youthful face.”

When it comes to volume loss and puffiness, there is a fine line between how much is too much. “An ideal candidate for under eye fillers is someone that has a modest loss of volume, mild bulging of fat pads, and modest skin laxity under the eye region,” Dr. Spence says. This means age will be a factor. Dr. Rabach says ideal candidates for under eye filler are generally “younger” – meaning twenties, thirties, and forties. 

Skin quality matters as well, Dr. Tepper notes. “Thicker skin,” Dr. Rabach says, is better suited for filler because it usually blocks any visible under eye vessels that can cause discoloration. Additionally, she said the region should have little to no pigmentation (another common cause of dark circles). 

Last but not least, under eye filler can be an option for “people who are not ready for surgery,” Dr. Parsa says. In such cases, however, it’s important to know what you are signing up for. “There is definitely a limitation on how much they work,” he notes. “And the key here is to understand that fillers are not a permanent solution.” Though they may hang around longer than expected. “Fillers last many years, even though we are told they last only six months,” he cautions. 
### **Non-Candidates for Under Eye Filler**
Generally speaking, “someone who is older with larger bags, lots of excess skin, pigmentation, and/or very thin skin” would not be a good candidate for under eye filler, Dr. Rabach says.

As it relates to most dark circles, filler is not a fix. “Filler cannot correct issues such as genetic hyperpigmentation or blood vessels shown under the eyes,” Dr. Callahan shares. Similarly, it can’t necessarily contour away puffiness. “Some patients lack under eye hollows and instead have more fullness or ‘bags,’” Dr. Ahmedli says. “This creates a bubbling look in which the under-eye bulges forward and accentuates the tear trough groove underneath leading to a harsher separation between the under eye and cheek.” Filling the area can exacerbate this.

It’s also important to consider the anatomy of your entire face – not just the under eye. “If the patient lacks cheek fat, then filling the tear trough groove becomes tricky,” Dr. Ahmedli cautions. “A provider cannot fill the groove to maximal correction because the lower lid will appear even puffier, creating the dreaded ‘chipmunk’ look.” Dr. Spence agrees that those with “severe volume loss from the cheek are not going to be the ideal candidates for under eye filler.” Ultimately, Dr. Callahan says you need to identify the actual culprit of your aesthetic concerns. “Filler will not help if the real problem is lack of volume in the cheeks just below the dark circles,” she notes.

Another thing to keep in mind? Your health. “A bad filler candidate is someone who suffers from chronic/seasonal allergies (itchy swollen eyes), puffy lower eye bags, fluid retention syndrome (eye bags that swell in the morning or based on what you eat), and those who have a significant amount of loose skin under the eyes,” Dr. Parsa shares. “Adding volume with HA filler to the undereyes will make things look worse in these situations.”
### **Do You Actually Need a Blepharoplasty?**
We’ve talked a lot about why you might not be a good candidate for under eye filler if you have under eye bags, puffiness, and skin laxity. What may be a solution, however, is a surgical blepharoplasty. “Blepharoplasty is a surgical procedure aimed at rejuvenating the eyelids,” Dr. Callahan explains. “It involves the removal of excess skin, fat, and sometimes muscle from the upper and/or lower eyelids.” 

When it comes to the lower lid, the eyelid surgery can address eye bags and skin laxity concerns. “Lower eyelid blepharoplasty, or lower eyelid lift, allows for excess skin to be removed and for the fat pockets to be contoured and repositioned to improve the appearance of the puffiness and the tear trough groove,” Dr. Ahmedli shares. As Dr. Tepper explains, a blepharoplasty is the preferred treatment if “tear trough deformity is moderate to severe” and “there is excess fat protruding in the lower eyelids.” While “filler will not correct or address this,” he says, “the fat can be removed or transposed” surgically.

For some patients, under eye filler is a gateway to blepharoplasty. “It is more common for younger patients to begin with under eye filler given the lack of excess skin,” Dr. Ahmedli notes. But that is not always the case. “A lot of our patients think the best way to treat their under eye concerns is by adding volume with filler,” Dr. Parsa says. “We have had countless patients come to us to remove their under eye filler and proceed with a blepharoplasty for long-term results.” In such cases, the under eye filler must be completely dissolved before proceeding with surgery, he adds.

For others, surgery is the best and only option. “If the real problem is fat pad herniation (a.k.a. eye bags) then surgery is the best choice,” Dr. Callahan says. Additionally, “if a patient has excess lower eyelid skin that is bunching, then blepharoplasty is a better option than filler,” Dr. Ahmedli shares. Ultimately, “a patient with significant skin laxity and bulging fat pads with volume loss to the cheeks is better served with a surgical approach,” Dr. Spence says. “The procedure actually removes excess skin and fat rather than filling in any hollowness.”
### **The Takeaway**
Under eye filler can be a rejuvenating treatment that instantly revitalizes the eye area, but it is important to understand that it has its limitations. Fillers will add volume to an area and are great for problems due to a loss of volume such as dark circles. For under eye issues due to abnormally enhanced volume, such as eye bags or festoons, under eye fillers are not appropriate and can exacerbate your problem. Says fellowship trained Facial Plastic Surgeon, [Dr. William A. Kennedy, MD](https://aedit.com/provider/william-kennedy-md-26292). If you are interested in under eye filler and think you may be a candidate, The AEDITOR — the patented 3D Aesthetic Simulator available exclusively in the AEDIT iOS app — allows you to ‘try on’ the procedure and instantly visualize medically accurate results. Download the app here, and, once you give it a try, consult with a board certified dermatologist or plastic surgeon to determine if under eye filler is the right treatment option for you.

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Are You a Candidate for Under Eye Filler? 

Are You a Candidate for Under Eye Filler? Here’s How to Tell

Maximize your Botox and Filler

[Botox®](https://aedit.com/procedure/botox) and [soft tissue fillers](https://aedit.com/procedure/dermal-fillersinjectables) have gained immense popularity over the years. The two accounted for nearly 60% of all minimally-invasive cosmetic procedures in 2020 — and there’s good reason for it. Relative to other, more invasive, cosmetic surgeries, [Botox®](https://aedit.com/procedure/botox) and [dermal fillers](https://aedit.com/procedure/dermal-fillersinjectables) are much more affordable, require significantly less downtime, and carry fewer health risks. That being said, there is one major drawback: the results are temporary. Fortunately, there are certain behaviors and habits that we can introduce — or eliminate — to get the most out of our treatments.

So, what can you do to widen the gap between dermatologist visits? Read on for tips and considerations to maximize your [Botox®](https://aedit.com/procedure/botox) and [dermal fillers](https://aedit.com/procedure/dermal-fillersinjectables).

## **How Long Do Injectables Last?**
For better or worse, injectables like Botox® and dermal fillerswear off over time. Botox® typically lasts three to six months and most dermal fillers last around six to 12 months. There are a number of factors that play into the longevity of the injections —  some in our control and others not. The location of the injection is a key factor for how long the injectable will last. In general, muscles that are used more frequently will break down the toxin or filler at a faster rate. Muscles around the forehead, eyes, lips, and mouth are typically more active and, as a result, Botox® and filler may fade away more quickly when targeting those areas. Our metabolisms are another factor that impact injectable lifespan. Having a strong metabolism is a blessing for a number of reasons, but not when it comes to Botox® and dermal fillers. A fast metabolism can break down the toxin and filler  at a higher rate.

“Making sure the patient is the right candidate and accurately determining which injectables to do and where is highly important to ensure best results,” says [Amanda Doyle, MD](https://aedit.com/provider/amanda-doyle-md-31526), a board certified dermatologist at Russak Dermatology in NYC. “Going to a board certified dermatologist and / or plastic surgeon is likely to yield the best outcome. Even with the right doctor and right injections, if you have a fast metabolism, it’s possible that the treatments may not last as long.”

For patients who want longer-lasting results, the release of DAXXIFY™, a new anti-wrinkle injection and Botox® alternative, may be a better option once it’s commercially available in 2023. DAXXIFY™’s effects have been shown to last six to nine months, making it an appealing option for those wanting fewer injections. According to [Dr. Doyle](https://aedit.com/provider/amanda-doyle-md-31526), maintenance for DAXXIFY™ looks similar to Botox® and other neuromodulators like [Dysport®](https://aedit.com/procedure/dysportr) and [Xeomin®](https://aedit.com/procedure/xeomin). Whether it’s DAXXIFY™, Botox® or filler, the following expert advice is sure to help you get the most out of your treatment.

## **Expert tips on how to maximize Botox®  and filler injections**


### **Be extra attentive the first 24 hours**


Given the hefty price tag, the last thing you want to do is disrupt the injections as they make their way through the face. With that in mind, it’s best to leave the targeted area stationary and isolated to prevent the injections from dissipating. NYC-based board certified dermatologist [Brendan Camp, MD](https://aedit.com/provider/brendan-camp-md-34645), warns against lying down for at least four hours post procedure to avoid diffusion of the product. Further, [Dr. Camp](https://aedit.com/provider/brendan-camp-md-34645) says facial massages, exercises with inversions, like yoga, and hats or headbands are all a no-go for at least the first 24 hours. Washing your face within the first day is doctor-approved, but you’ll want to be extra gentle and wait at least a few hours after the treatment. 

### **Avoid sun Damage**

It’s no secret that the sun’s harmful rays can cause skin damage in the form of redness, discoloration, and wrinkles. While it’s always important to protect the skin from ultraviolet (UV) rays, it’s even more pertinent for those undergoing dermal filler treatments. Research has found that the sunlight’s UV rays can degrade the hyaluronic acid found in fillers. [Dr. Camp](https://aedit.com/provider/brendan-camp-md-34645) explains that unprotected sun exposure can stimulate enzymes in the dermis, which contributes to the breakdown of normal skin and injected hyaluronic acid. Not only would unprotected sun exposure decrease the lifespan of the fillers and demand more frequent injections, but [Dr. Camp](https://aedit.com/provider/brendan-camp-md-34645) says it can also continue to cause fine lines and wrinkles and a need for a higher dosage of neurotoxins to relax the skin.

### **Manage Stress**

We know, easier said than done. We’re not suggesting you need to eliminate stress completely, but it’s beneficial to work on stress management — if not for your mental and physical health, then for your Botox® and filler. Increased stress can trigger the release of the hormone cortisol which has been known to sometimes reduce our own body’s ability to produce hyaluronic acid. “When this happens, volume loss may become even more noticeable more quickly even when hyaluronic acid filler is part of the regimen,” says [Dr. Doyle](https://aedit.com/provider/amanda-doyle-md-31526). Further, stress can cause us to inadvertently change our facial expressions and recruit more muscles between our eyebrows and around our eyes. When muscle movement is increased, [Dr. Doyle](https://aedit.com/provider/amanda-doyle-md-31526) explains that the effects of the toxin injections may not last as long. Consider incorporating a stress-relieving activity, like yoga or meditation, into your daily routine. 

### **Skip the high intensity workouts**

High intensity workouts may be good for your overall well-being, but they’re not good for the longevity of your Botox® or filler. Exercise can stimulate your metabolism which, in turn, increases the rate at which the neurotoxins and fillers are broken down. “If someone is committed to making their aesthetic investment last as long as possible, it is recommended to integrate more low and moderate intensity workouts into their routine,” says [Dr. Camp](https://aedit.com/provider/brendan-camp-md-34645). The takeaway? Next time you’re thinking about attending your gym’s HIIT class, consider a long-distance run instead.

### **Keep a healthy wellness routine**
Practicing healthy habits is another critical piece to maximizing Botox® and filler injections. While the treatments help reduce the signs of aging, they have their limitations. Botox® and dermal fillers won’t clear up your skin’s complexion, but maintaining a healthy lifestyle sometimes can. Sugar and unhealthy fats can cause inflammation, breakouts, and uneven skin while inadequate hydration can lead to dry skin, eczema, and discoloration. Maintaining a good skincare routine, refraining from smoking, and limiting alcohol consumption can also lengthen the results of fillers and Botox®.

### **Integrate hyaluronic acid into your skincare routine**

Botox® and dermal filler can do wonders when it comes to smoothing out fine lines and rejuvenating the skin, but to achieve even better results, [Dr. Doyle](https://aedit.com/provider/amanda-doyle-md-31526) recommends pairing with hyaluronic acid serums and Revision Revox. The hyaluronic acid helps support and hydrate the skin and the Revision Revox can mimic the toxin injections by softening fine lines and wrinkles. Adding these two products into the mix can improve the results of the filler injections and make your skin look even more flawless.




Expert Opinion

What can you do to widen the gap between dermatologist visits for your Botox® and filler injections? Read on for tips and considerations to maximize your results.

How to Maximize Your Botox and Filler Injections

cesar-la-rosa-sGZwj1Nmq8s-unsplash

If you would have asked me a couple of years ago what one aesthetic treatment I would absolutely not be interested in, I wouldn’t have hesitated to say [lip filler](https://aedit.com/procedure/temporary-lip-fillers). I had nothing personally against the minimally invasive lip enhancement procedure – and I had certainly interviewed enough top injectors who sang its praises – but, for me, I just couldn’t get past the fact that it felt like every influencer and reality TV personality increasingly had a mouth that looked all-too-similar and all-too-supernatural. 

I am usually the first person to tell you that aesthetic medicine has long gotten a bad rap because we tend to only spot the overly augmented or unnatural work while more subtle tweaks go unnoticed, save for recognizing that the person looks great. Lip filler is but another cosmetic treatment that falls into this trap. Yes, we’ve all seen a lot of so-called ‘duck lips’ or ‘trout mouths’ that may or may not be your taste (personally, I am in the ‘nay’ camp). But we’ve also all seen a lot of plush pouts that are [perfectly proportional](https://aedit.com/aedition/facial-harmony-in-aesthetic-medicine) to the rest of the face – and there is a good chance that those lips are filled, too.

I sit here today eating a helping of humble pie (what’s that they say about never saying never?) as I write this article about why I decided to fill my lips, and, better yet, why I am so happy with the results that hardly anyone has noticed. In early April, New York City-based board certified plastic and reconstructive surgeon [David Shafer, MD](https://aedit.com/provider/david-shafer-md-153), injected me with one syringe [Juvéderm® Volbella XC](https://aedit.com/procedure/juvederm) (split between my upper and lower lip), and I’ve been spending the last couple of months thinking about what I learned from the experience that might benefit others who are on the fence about going under the needle. 

Below, I’ve compiled a list of the six things I believe are useful to know if you are considering getting lip filler. Read on to get the scoop and to see my before and after photos.

### **1. Not All Lip Fillers Are the Same**
If you are a regular reader of The AEDITION, you’ve likely seen our breakdowns of the different types of [cosmetic injectables](https://aedit.com/procedure/dermal-filler-and-injectable-solutions) that exist. Within the filler category, there are [hyaluronic acid (HA)-based and biostimulatory options](https://aedit.com/aedition/hyaluronic-acid-filler-vs-biostimulatory-injectables). Within the HA family, there are an array of brands (think: Juvéderm®, [Restylane®](https://aedit.com/procedure/restylane), [Belotero®](https://aedit.com/procedure/belotero), etc.). And within each brand, there are a variety of different products that have been designed and, in on-label use cases, approved by the United States Food and Drug Administration (FDA) for specific purposes. “Juvéderm® Ultra XC is the original hyaluronic acid filler FDA approved for lip augmentation,” Dr. Shafer says. “It works well for plumping and adding volume.”

Juvéderm® Ultra XC may be the OG, but it has a younger sister that can treat the lips in a similar but different way. “Volbella is a newer generation hyaluronic acid filler in the Juvéderm® family that is good for smoothing and hydrating,” he shares. “As Volbella is a smoothing filler, it is also great for softening perioral lines such as the vertical ‘smoker lines’ on the upper lip and any creases which have formed from years of dynamic lines around the mouth, such as the smile lines.”
 
While each filler can be used individually (I only got Volbella), they can also be paired together to better treat a patient’s aesthetic concerns. “I prefer a hybrid lip augmentation technique with both Juvéderm® Ultra XC and Juvéderm® Volbella XC to both plump and smooth,” Dr. Shafer says. This allows him to “achieve the best results.”

Why am I bringing this up? You don’t need to walk into your injector’s office demanding a certain type of filler — they are the expert and, during a [consultation](https://aedit.com/aedition/questions-to-ask-your-doctor-during-plastic-surgery-consultation), will be able to share what brand and product is suited for your anatomy and aesthetic goals. Even so, it’s helpful to know that lip filler (and filler in general) is not one size fits all. What’s best for your friend or sister or some person you saw on TikTok, may not be best for you. You should feel free to ask your provider what types of filler they offer, why they think something is right for you, and what you can expect from the result. 

### **2. You Can Maintain Your Lip Shape**
This was a big one for me. Everyone has their own preferences when it comes to [lip shape](https://aedit.com/concern/lip-shape) and [lip size](https://aedit.com/concern/lip-size), and some people turn to lip filler to address both. Personally, I’ve always liked the shape of my lips. I naturally have a pretty well-defined [cupid’s bow](https://aedit.com/aedition/cupids-bow-cosmetic-surgery-fillers-for-lip-augmentation), as well as upper and lower lips that gradually taper out to the corners. Overall, I felt like my mouth fit my face, but the lips themselves were a little thinner than I wanted them to be (especially my top lip). 

<CaptionImg url={https://images.ctfassets.net/zw35sfestf1t/6gwjkcb34StQ85wwJBthk7/0353be5dba7684be311bdbb1e490628e/MegLipBA-1.jpg}>
  The writer before (*left*) and 72 hours after (*right*) her lip filler treatment.
</CaptionImg>

Because I was overly fixating on some of the more obviously augmented pouts that populate my social media feed, I was concerned that I was going to have to sacrifice the shape of my lips to enhance the size. I thought I would automatically end up with a kind of elongated and tubular upper lip shape that some people might like — it’s just not what I was going for. I am pleased to report that, in the hands of a skilled injector, the shape of your lips can be preserved while subtly enhancing the volume. 

The key: Be clear about what you want and don’t be shy when communicating it to your provider. Natural-looking lips (like any facial feature) are about [proportion](https://aedit.com/aedition/plastic-surgery-results-are-about-proportion-not-perfection), so bringing in a picture of Angelina Jolie’s plush pout isn’t particularly helpful. Instead, telling your injector exactly what you like about your lips and exactly what you don’t is the best way for them to get an understanding of what you are looking for. They will be able to make recommendations and select the proper filler for you from there. 

### **3. The Injections Don’t Hurt**
The lips are one of the most sensitive parts of the body, which means the thought of putting needles into them isn’t particularly pleasant. But here’s the thing about lip filler injections – they don’t hurt (and [you don’t just have to take my word for it](https://aedit.com/aedition/what-to-know-before-getting-lip-filler-for-the-first-time)). Dr. Shafer put [numbing cream](https://aedit.com/aedition/numbing-cream-breakouts) on my lips and left it on as he prepared the filler and injected Botox® into my forehead, glabellar lines, and crow’s feet (I got both injectable treatments done at the same appointment). After about 10 minutes, he wiped off the residue and began injecting my lips. It was a total of four pricks, and, between the numbing cream and the lidocaine in the filler, I didn’t feel anything more than a poke. 

Before sending me on my way, Dr. Shafer told me to massage or rub my lips together more than normal in the coming hours and days to “ensure a smooth result.” While the anesthetics were all still active, this was no problem. As they wore off, however, this became a bit more challenging. The injections themselves were painless, but I did experience some mild discomfort as the day went on. I saw Dr. Shafer in the morning, and, by late afternoon, my lips were tender to the touch – and rub. The act of pressing them together induced a stingy, bruise-like sensation (though I didn’t have any visible bruising). By the next morning, this tenderness had greatly subsided; by the end of the day, it had all but disappeared. At that point, I went back to rubbing them together again as per his instructions.

Aside from the massaging, Dr. Shafer suggests avoiding straws for several days after injections. Kissing is okay after 24 hours, he says, and there is no restriction on exercise. Another thing to keep in mind: Salty food may make swelling last longer, which leads me to…

### **4. The Swelling Is Real, But Short Lived**
The discomfort I experienced in the hours proceeding the filler injections was accompanied by [swelling](https://aedit.com/aedition/how-to-treat-minimize-swelling-after-cosmetic-surgery). “After any injection, patients may have swelling and possible bruising,” Dr. Shafer says. “Swelling can last 24 to 48 hours and usually is quite subtle.” As my lips got more tender, they also got firmer and a little bigger. The swelling seemed to peak around 7 p.m. (about eight hours after my appointment). When I woke up the following morning, the swelling had mostly dissipated and it continued to over the course of the next day or two.

<CaptionImg url={https://images.ctfassets.net/zw35sfestf1t/4b2SMwwXpk1Si3XVcBXEn4/efb7340da49b07034c3df20de18f3d2e/MegLipSwelling.jpeg}>
  From left: The writer immediately after, 6 hours after, and 24 hours after her lip filler treatment.
</CaptionImg>

Dr. Shafer gave me an ice pack immediately after he finished injecting me, and I used it on both the areas he treated with Botox® and my lips. I probably did about 10 minutes of icing in the office and then another 10 to 15 minutes when I got home an hour later. I drank an iced beverage – without a straw! – most of the afternoon, and the cold felt good against my lips. When I noticed the discomfort and swelling start to set in around 5 p.m., I reached for the ice pack again and alternated 10 minutes on, 10 minutes off for about an hour. I don’t know if it did anything to reduce the swelling, but it definitely helped ease the sting.

I didn’t experience any [bruising](https://aedit.com/aedition/how-to-treat-prevent-bruising-after-lasers-filler-botox), and Dr. Shafer says it’s rare. “If it does [occur], then it may take five to seven days to resolve,” he shares. “We offer complimentary laser treatments for any patient with a bruise to help it resolve faster.”

### **5. You’ll Need Less Lip Balm**
I’ve heard anecdotes about HA fillers hydrating the lips, but this one still surprised me. While my lips don’t get particularly chapped, I am the type of person who needs to have something slathered on them at all times for risk of having them feel dry (I can’t handle that sensation). I have a stable of balms, oils, and masks I rotate between throughout the day and overnight, and, while I still reach for them, I've realized that it’s now more out of habit than necessity. 

Since I got my lips filled, they rarely, if ever, look or feel dry. Because of the fact that it’s largely comprised of [hyaluronic acid](https://aedit.com/aedition/guide-to-hyaluronic-acid-in-skincare-dermal-filler) (a humectant that draws moisture into the skin and can hold 1,000-times its weight in water), Juvéderm® Volbella XC is known as a ‘hydrating’ filler. In my experience, that has meant that my Volbella-infused lips have a perpetually smooth appearance and a perpetually moisturized feel. I still love lip balm and apply it often, but I’ve been opting for peptide- and HA-based formulas – like the [PCA Skin Hyaluronic Acid Lip Booster](https://go.skimresources.com?id=170670X1638612&xs=1&url=https%3A%2F%2Fwww.dermstore.com%2Fpca-skin-hyaluronic-acid-lip-booster-0.24oz%2F12039671.html) and [Theraderm Anti-Aging Lip Complex](https://go.skimresources.com?id=170670X1638612&xs=1&url=https%3A%2F%2Ftheraderm.net%2Fanti-aging-lip-complex) – that have a subtle plumping quality to further enhance my results.

### **6. Nobody Has to Notice**
Depending on your aesthetic goals, the idea that no one really noticed you got lip filler might not be appealing. For me ([much like when I got nasolabial fold filler late last year](https://aedit.com/aedition/what-its-like-to-get-nasolabial-fold-filler)), it’s the best part. My lips are subtly enhanced in a way that I relish every time I look in the mirror or smile in a photo, but not in a way that has had any of the people I see most often asking me what I had done. My mom noticed the difference; most of my coworkers did not. 

I obviously have Dr. Shafer to thank for (1) really listening to my concerns and (2) choosing the right filler and injection technique for me. “As Volbella is a soft, smoothing hyaluronic acid filler with a less plumping effect, it is good for first-time users who are looking for subtle effects,” he shares. “I tend to be conservative, as we can always add more later.” Down the line, I could also consider trying a different combination of products. “Once a patient sees the potential of lip fillers, the hybrid technique is usually best for subsequent treatments,” he explains. “It's good to start out subtle and then get more aggressive with treatments depending on the patient's goals.”

<CaptionImg url={https://images.ctfassets.net/zw35sfestf1t/3Djvs7bTROxfR7s1s1arf4/4a9a5407348e4198d42f9e538eea7082/MegLipBA-2.jpg}>
  From left: The writer before, 72 hours after, and one month after her lip filler treatment.
</CaptionImg>

Two months after treatment, I am thrilled with the results. As for how long I can expect to enjoy them, every patient is different because every body metabolizes filler differently. With that said, Dr. Shafer offers a simple way to think about scheduling touch ups. “For most patients, we set them on a schedule of Botox® every four months and fillers every other Botox® appointment, so every eight months,” he shares. 

This cadence is ideal for those who don’t want a lapse in their look. “There is a difference between how long the filler is present versus how long the clinical effect is apparent,” Dr. Shafer explains. “That is why you may hear a filler lasts 12 to 18 months, but, in reality, the next treatment would be sooner than that.” Think about it like topping off your gas tank. “Similar to when you fill your gas tank, you don't usually wait for it to go to empty before filling the tank back up,” he says.

## **The Takeaway**
If you had told me a few years ago that I would be writing an article about my experience getting lip filler, I wouldn't have believed you. But the more I’ve learned about the treatment, the more I realized that it could be minimally invasive in more ways than one. Sure, the results are immediate with little pain and no downtime. Even better, however, is the fact that the benefits can be truly customized to your anatomy and aesthetic goals. It all comes down to being clear about what you want and visiting a highly skilled injector. 

If you are on the fence and curious about how you would look with lip filler, [The AEDITOR](https://apps.apple.com/US/app/id1322246202?mt=8) — the patented 3D Aesthetic Simulator available exclusively in the AEDIT iOS app — allows you to ‘try on’ the procedure and instantly visualize medically accurate results. [Download the app here](https://apps.apple.com/US/app/id1322246202?mt=8), and, once you give it a try, consult with a board certified dermatologist or plastic surgeon to determine if lip filler is the right treatment option for you.

*All products featured are independently selected by our editors, however, AEDIT may receive a commission on items purchased through our links.*

Patient Perspective

A beauty editor shares her experience getting Juvéderm® Volbella XC lip filler for subtle lip augmentation.

What It's Like To Get Lip Filler: Before And After Photos

I Swore I Would Never Get Lip Filler – And Now I Wish I Tried It Sooner

shutterstock 1760754215

Hyaluronic acid-based fillers work somewhat like magic. Injecting them into the appropriate facial planes allows for deflated areas – such as the [cheeks](https://aedit.com/procedure/cheek-augmentation-with-fillers), mid-face, temples, and [lips](https://aedit.com/procedure/temporary-lip-fillers) – to experience an immediate improvement in volume and contour. Often, dermatologists and plastic surgeons veer on the conservative side and take a less is more approach when filling. After all, adding too much volume in any one area, at any one time can lead to an unnatural appearance. However, some patients require more volume than others, which may call for multiple syringes to achieve the desired effect.

Lately, we’ve talked a lot about [overfilled facial features](https://aedit.com/aedition/hyaluronidase-to-dissolve-dermal-filler), [filler migration](https://aedit.com/aedition/why-lip-filler-migrates), and [filler fatigue](https://aedit.com/aedition/dermal-filler-fatigue), which are just a few of the reasons why the concept of injecting large amounts of filler may sound scary. The truth is, in inexperienced hands, it can be. But, if you are working with a highly skilled injector who understands your aesthetic goals, it’s possible for the specialized technique to be both safe and effective. Here, top physicians break down everything you need to know about large-volume filler. 

## **Large Volume vs. Overfilling: What’s the Difference?**
The term ‘large-volume filler’ is relative. It depends on the treatment area and the anatomy of the patient. Generally, it refers to injecting more than the ‘typical’ amount of filler required for a noticeable change in the average patient, says [Jonathan Cabin, MD](https://aedit.com/provider/jonathan-cabin-md-956), a double board certified facial plastic and reconstructive surgeon in Arlington, VA. “I consider ‘large volume’ anything more than a single syringe (one cc) of filler,” he explains. For context, about five syringes of filler are needed to achieve one teaspoon's worth of volume, says [Joshua Zeichner, MD](https://www.instagram.com/joshzeichnermd/?hl=en), a board certified dermatologist in New York City. He adds that a typical ketchup packet contains about seven syringes worth of filler — just a little food for thought.

While large-volume filler equates to a larger, albeit appropriately used, dose, there is some confusion between it and [overfilling](https://aedit.com/aedition/how-to-correct-overfilled-facial-features). A clear distinction exists between the two:

- Overfilling refers to excessive and inappropriate filler placement
- Large-volume filler precisely injects more-than-average doses into the appropriate facial planes

Dr. Zeichner explains that, when placing more volume, the outcome is 100 percent determined by the skill and aesthetic of your injector. “It is no different than going to the museum and seeing a Monet versus a van Gogh,” he shares. “It's the same oil paint just used differently on the canvas.” If the injections are appropriate, the results should be natural and complement, not hinder the patient's appearance. “When the filler is not placed where it should be, patients often look odd or overfilled,” Dr. Zeichner adds.

We all know what an overfilled face looks like, and, unless that's the aesthetic you're going for, most people try to avoid it at all costs. For that reason, it's understandable why some patients get nervous that they will end up looking overfilled when their provider lays out four or five syringes of filler. Seeing a medical [tray of needles](https://aedit.com/aedition/guide-to-needles-used-for-cosmetic-injectables-botox-filler) does more than send off sirens that a substantial bill waits for you at the front desk. Dr. Zeichner says patients are more so afraid of looking overfilled and fake, than the price tag.

## **The Ideal Candidate**
Whether you need half a syringe or five ccs, a full assessment is vital before your provider injects a single drop of filler into your face. This includes studying the anatomy of the treatment area and its relationship to the rest of the face, in addition to learning more about your aesthetic goals. Not every patient needs the major volume technique, and the degree of evident aging determines who benefits from it and who doesn't. 

Typically, those with a significant [volume deficit](https://aedit.com/aedition/best-procedures-to-restore-facial-volume) and/or [asymmetries](https://aedit.com/aedition/cosmetic-procedures-for-body-asymmetries) are candidates for multiple syringes of filler. As such, age is not a factor when it comes to who can reap the benefits. More mature patients who require significant volume restoration and younger patients who mandate facial balance are often contenders, says [Michael Schwartz, MD](https://www.drschwartz.com/), a board certified plastic and reconstructive surgeon in Los Angeles. “Full facial balance restoration improves proportions and [creates harmony](https://aedit.com/aedition/facial-harmony-in-aesthetic-medicine) within the features instead of augmenting one area,” he explains. “It requires more product because we treat the face entirely to achieve natural results.” However, patients seeking intentional exaggeration of specific features that are not harmonious with the face's natural contours may not be well-suited for large volume injections, adds [Shirley Madhère, MD](https://elementsandgraces.com/about), a holistic plastic surgeon in NYC and founder of [Jet Set Beauty Rx](https://jetsetbeautyrx.com/).

Sometimes, it can be challenging for doctors to educate their patients on how much volume loss they have – and for patients to accept it – “but it is an important conversation to avoid potential disappointment, especially if a patient does not get the result they are looking for when using fewer syringes,” Dr. Zeichner explains. The last thing any provider wants is for a patient to invest in their face and not be happy with the results simply because there is a need for more product.

## **The Right Way to Do It**
What constitutes large-volume filler depends on each patient's face and how much filler they can safely benefit from, says [Kenneth Mark, MD](https://kennethmarkmd.com/), a board certified dermatologist with offices in New York, Aspen, and the Hamptons. Despite the volumizing benefits, he finds patients can be skeptical of substantial amounts of filler because of the suboptimal outcomes they’ve seen on social media from either too much of the wrong filler or poor injections in the wrong places. This rightfully creates legitimate concern amongst patients when they hear the words ‘large-volume filler.’

Using filler as an alternative to traditional cosmetic surgery procedures (like a [rhinoplasty](https://aedit.com/aedition/facts-about-liquid-rhinoplasty) or [chin implant](https://aedit.com/aedition/best-chin-augmentation-enhancement-procedures)) and in areas that require more noticeable correction (think: jawline, temples) call for larger volume – often two syringes of filler or more – says Dr. Cabin. “The nose and chin are unique in that fillers create changes in two-dimensional shape in the profile view, as opposed to three-dimensional facial volume change goals with other areas,” he explains. The chin typically requires one to four ccs of filler to create the necessary balance. When injecting insufficient amounts of filler, the results will not be noticeable and can even call unwanted attention to a specific feature.

In the hands of an expert injector who understands the nuances of filler and anatomy, using more than moderate amounts of product can create an aesthetically pleasing result, especially when the placement is deep. “It makes a big difference," says Dr. Zeichner, who regularly uses five or more syringes (often in a single session). “Most of my injections tend to be deep, down to the level of the bone,” he notes. This technique helps provide structure, support, and mattresses to lift and reposition the overlying soft tissue and skin. “If all of the injections are superficial, it weighs down the face and makes the patient look overfilled,” he cautions. Deep placement creates the opposite effect.

Deep injections also create a smoother appearance – sans bumps, lumps, and irregularities. Not injecting more robust fillers deep enough can cause superficial lumps, nodules, and a blue tinge to the skin, known as the Tyndall effect. “When injecting thicker fillers into the skin, it is important to employ a technique that places the filler in the layer of skin that is appropriate to accept the dynamic properties of that filler,” Dr. Madhère explains.

In the case of large-volume fillers, Dr. Mark likes to use a layering technique. Layering is just what it sounds like and consists of placing fillers in various depths of the skin and locations as needed over time. He says layering filler and staging it out over multiple sessions avoids overcorrection and provides natural-looking results. “Utilizing this method and pinpointing precise placement has allowed me to avoid complications and obtain optimal cosmetic results,” he adds.

Technique aside, injecting the right fillers in the right place is essential. Dr. Madhère says thicker hyaluronic acid-based fillers, like [Juvéderm® Voluma](https://aedit.com/procedure/juvederm) and [Restylane® Contour](https://aedit.com/procedure/restylane), occupy more space. But it's not just hyaluronic acid filler that fits the bill. Injectables that fill more robustly, including [Sculptra®](https://aedit.com/procedure/sculptra), which provides a scaffold for a volumizing effect, may be used. “Additionally, thick and long-lasting calcium-based [Radiesse®](https://aedit.com/procedure/radiesse) can also be used,” she explains. “So can [fat injections](https://aedit.com/procedure/facial-fat-grafting), but they involve a surgical procedure and additional costs.” No matter what filler you and your provider ultimately decide on, it's always important to find an injector that understands the differences between the products and where to place each one.

Just like every patient isn’t a candidate for large-volume fillers, not every facial feature should be treated with the technique either. The parts of the face that tend to respond well include the temples, cheeks, midface, and jawline. Dr. Madhère advises against using a lot of volume in the [forehead](https://aedit.com/aedition/cosmetic-forehead-procedures) and [eye area](https://aedit.com/aedition/under-eye-filler-pros-cons), as they can swell and cause undesirable puffiness.

## **One Session or Multiple: Which Is Best?**
There are plenty of patients that only need a bit of filler and respond well to an average dose. Yet, the ‘a little filler goes a long way’ rule doesn't apply to everyone. Dr. Zeichner says that “more filler goes a long way” for many of his patients. And, when there is a need for significant volume and it is within a patient's budget, he prefers injecting it all at once. “This means less anxiety over the visits and a single period of downtime versus multiple visits with potential bruising after each one,” he shares.

Some providers, meanwhile, choose to space out the injections. For example, Dr. Cabin rarely does large volume filler in a single appointment. Instead, he performs spreading out large-volume injections over a few visits because, as he says, there’s a greater chance of unnecessarily high levels of short-term swelling. “The filler tends to settle better when I inject it over several sessions,” he notes. “It settles and creates a more natural correction.”

[Swelling](https://aedit.com/aedition/how-to-treat-minimize-swelling-after-cosmetic-surgery) may be one reason to break the injections up, but there's also the potential for volumetric changes that patients don't know to account for. A filler may be a specific volume when it is going in and, most of the time, that volume increases since the product naturally pulls in water from the surrounding tissue (hence, post-treatment swelling). Some of this extra water can remain, causing what Dr. Cabin describes as a more considerable volume change than you would anticipate from the syringe volume alone. Volume fluctuations are another reason why some providers avoid injecting large amounts of filler at once.

## **How Long It Lasts**
The more product your provider injects, the longer it can take to break down and for the area to return to baseline. So, injecting more filler may equate to longer-lasting results, but there is a lot that goes into how long filler results last. “Longevity depends on several factors, including, but not limited to, the main ingredient, chemical composition, amount injected, and patient's metabolism,” Dr. Madhère explains. 

While injectable brands provide an average of how long each product lasts given its intended use (i.e. up to one year), those timeframes vary from one person to the next. “Everyone metabolizes fillers differently, so I like to start with full correction treatment and then follow-up with a [maintenance plan](https://aedit.com/aedition/how-frequently-to-get-non-surgical-cosmetic-procedures-like-dermal-filler-botox-chemical-peel) to keep the results up,” Dr. Schwartz says.

## **The Takeaway**
If your doctor says you'll benefit from multiple syringes of filler, it doesn't mean you will end up with an overfilled face that looks doughy or unnatural. In fact, some patients sport numerous syringes of filler, and no one but them and their injector knows. More often than not, it’s poor injection technique and improper placement that will land you in the ‘done and don't’ category. Ultimately, the decision is yours, but, with the help of an expert injector who understands how to use more robust amounts of filler to replace lost volume or correct asymmetry, you may be happier with the outcome. In the right hands, more can be more.

Dermatologists and plastic surgeons break down the benefits of injecting large volumes of filler for certain patients.

The Pros And Cons Of Large-Volume Filler Injections For Volume, Symmetry, Contour

Why Injectors Say Not To Be Afraid Of Large-Volume Filler

motoki-tonn-ezOKZhYJAFo-unsplash

The invasiveness and permanency of a surgical procedure are often big considerations for those interested in going under the knife – you’ll likely have some downtime and there’s no going back. The market is ripe with non-surgical treatment options ([we recently broke down some of the most exciting advancements](https://aedit.com/aedition/best-new-nonsurgical-aesthetic-procedures)), but few cosmetic surgeries have a non-surgical counterpart that can offer similar results, sans operation. One of those unicorn pairings, however, is the ever-popular [surgical rhinoplasty](https://aedit.com/aedition/difference-between-cosmetic-rhinoplasty-vs-functional-rhinoplasty) and its less invasive sister, the so-called [liquid rhinoplasty](https://aedit.com/procedure/liquid-rhinoplasty). 

You may already know that both procedures can enhance the [shape of the nose](https://aedit.com/concern/nose-shape) and address aesthetic concerns, but, as it turns out, their commonalities don’t stop there. In fact, a liquid rhinoplasty “is a great alternative to surgical rhinoplasty for those interested in improving the side view of their nose,” says [Usha Rajagopal, MD](https://aedit.com/provider/usha-rajagopal-md-1330), a board certified plastic and reconstructive surgeon and founder of [San Francisco Plastic Surgery & Laser Center](https://www.sfcosmeticsurgery.com/). As she explains, it can even “improve some function concerns, however, it’s mostly for those who want to contour the [profile view](https://aedit.com/concern/nose-angle).” This is especially true, she says, “if they have a hump or a nasal bump.” 

<a href="https://youtube.com/shorts/UwL56Kc7LrQ?feature=share" class="embedly-card" data-card-width="100%" data-card-controls="0">Embedded content: https://youtube.com/shorts/UwL56Kc7LrQ?feature=share</a>

Since you’ve undoubtedly seen transformative [before and afters](https://aedit.com/aedition/importance-of-before-and-after-photos-in-plastic-surgery) of liquid rhinoplasty on social media, it’s time to get to the bottom of what the procedure can and cannot do. Read on for the top five things you should know about the non-surgical nose enhancement solution.

## **1. It’s a Quick – But Temporary – Fix** 
The most obvious differences between a surgical rhinoplasty and a liquid rhinoplasty: [recovery and results](https://aedit.com/procedure/rhinoplasty-nose-job/recovery). “This is not a permanent procedure and not a substitute for a [surgical rhinoplasty](https://aedit.com/procedure/open-rhinoplasty),” Dr. Rajagopal says. But, unlike a traditional rhinoplasty that requires [anesthesia](https://aedit.com/aedition/everything-you-need-to-know-about-anesthesia) to perform, a couple months to [recover](https://aedit.com/aedition/rhinoplasty-recovery-healing-process), and a year or more for [full healing](https://aedit.com/aedition/how-long-does-it-takes-to-recover-from-cosmetic-surgery-procedures), it’s non-surgical counterpart “is only 10 minutes long and requires no downtime with minimal discomfort,” she notes. 

<CaptionImg url={https://images.ctfassets.net/zw35sfestf1t/73KFqQVXtqmJC9fNtOTlK9/8da13478592e7c853a81d8990bd93725/LiquidRhino3.jpg}>
  A before (*left*) and after (*right*) look at one of Dr. Rajagopal's liquid rhinoplasty patients.
</CaptionImg>

In her practice, Dr. Rajagopal uses a [Restylane®](https://aedit.com/procedure/restylane) product because “it’s hyaluronic acid and can give a nice lift to the area of treatment.” Like HA filler for other areas of the face, results last up to a year, at which point they need to be touched up. Should you experience buyer’s remorse, the filler is dissolvable via [hyaluronidase injections](https://aedit.com/aedition/hyaluronidase-to-dissolve-dermal-filler).

## **2. There Are an Array of Benefits** 
Strategically placed hyaluronic acid-based filler can shape and contour the nose. “The ideal candidate is a patient who only has one or two issues with their nose that they are unhappy with,” Dr. Rajagopal shares. For example, “if the tip plunges or dips affecting the smile,” they may be a candidate, she says. Others who may benefit from filler are those with petite sniffers. “A patient with a [smaller or shorter nose](https://aedit.com/concern/nose-size) can benefit, as the product can give them volume and elevating the nasal dorsum gives a nice aesthetic result,” she explains.

It can also work wonders for [nose bump](https://aedit.com/concern/nose-bump) concerns. “When I do a [liquid rhinoplasty](https://aedit.com/aedition/what-you-need-to-know-about-liquid-rhinoplasty), I’m actually adding product to camouflage a hump,” she explains. “I will go on either side of the bump to reduce its appearance, and, oftentimes, I will add to the tip of the nose to give it a little lift and give it a nice, smooth appearance.” 

<CaptionImg url={https://images.ctfassets.net/zw35sfestf1t/5Os1oMBPnUpi3PiuMqMPhY/d0d228eb363ffc4bc2ea160db5b69b7e/LiquidRhino2.jpg}>
  A before (*left*) and after (*right*) look at one of Dr. Rajagopal's liquid rhinoplasty patients.
</CaptionImg>

While it’s not the same as combining a [facelift and skin resurfacing](https://aedit.com/aedition/best-procedures-to-combine-with-a-facelift), [blepharoplasty and brow lift](https://aedit.com/aedition/combining-blepharoplasty-and-brow-lift), or [rhinoplasty and chin implant](https://aedit.com/aedition/combining-rhinoplasty-and-chin-augmentation), pairing a surgical and non-surgical rhinoplasty may be beneficial for those who feel prior surgery hasn’t achieved their desired look or for those who have experienced specific complications post-op – which leads us to…

## **3. It Can Address Certain Functional Concerns** 
Those who have undergone a surgical rhinoplasty may be aware of the potential complications, adverse effects, or suboptimal results. A liquid rhinoplasty may come into play for those not interested in a traditional [revision rhinoplasty](https://aedit.com/aedition/what-you-need-to-know-about-revision-rhinoplasty). “It can help some functional concerns, especially if patients have had a rhinoplasty done and have had a middle vault collapse or have the central part of the nose slightly depressed,” Dr. Rajagopal says. “This happens when some of the cartilage has been over-resected and the internal valve or the internal part of the nose hasn’t been opened up again.”

Candidates who experience [breathing problems](https://aedit.com/concern/breathing-issues) due to the projection of the nasal tip may find relief as well. “For those who have a [droopy tip](https://aedit.com/aedition/drooping-nose-from-aging), lifting it up can improve breathing function,” she shares. “Over-resected tips or nostrils can be improved.”

## **4. There Are Risks** 
We always emphasize the importance of finding a skilled injector. While no HA fillers are indicated for use in the nose area, liquid rhinoplasty can be safe and effective in the hands of a pro. Experience is particularly important in this case, however, because the nose area is at an increased risk of [vascular occlusion](https://aedit.com/aedition/risk-of-vascular-occlusion-after-dermal-filler), which is one of the most serious filler complications. “The nose has a lot of vascular structures and those connect directly to the eye or the brain,” Dr. Rajagopal explains. If filler is accidentally injected near or into a blood vessel, it can become occluded due to the pressure. Too much pressure can limit blood flow, leading to skin necrosis (read: death) and, in the most severe cases, blindness. 

Promptly dissolving the filler with [hyaluronidase](https://aedit.com/procedure/hyaluronidase) can remedy the situation without damage, but the provider must know what to look for (including how to delineate between normal [post-injection bruising](https://aedit.com/aedition/how-to-treat-prevent-bruising-after-lasers-filler-botox) and the discoloration caused by vascular occlusion). “That’s why it’s important to find an expert who knows how to handle those complications if they do occur,” she emphasizes. 

## **5. Not Everyone Is a Candidate** 
While there is a lot a liquid rhinoplasty can do, it is not for everyone. “Someone who has multiple concerns they are unhappy with and want to change may not be a good candidate,” Dr. Rajagopal says. Filler can augment the nose, but it can’t reduce its size. “Those who have a [big nose](https://aedit.com/procedure/nose-augmentation-and-nose-reduction-solutions) but want a significantly smaller shape won’t be able to achieve it,” she explains. “[Similarly], those with a wide nose – whether it’s a wide bridge or wide nostrils – may not be a good candidate.”

For some, liquid rhinoplasty can serve as an alternative to a surgical revision, but this is not a hard and fast rule. “Someone who has had a rhinoplasty done where a cartilage or silicone implant has been used and there is no space to put the product in may not be a fit for a liquid rhinoplasty,” she shares. She makes these decisions on a “case-by-case basis.”

<CaptionImg url={https://images.ctfassets.net/zw35sfestf1t/1amKjyaVhwrMNRvrQaZg9w/712e68ec614820b115a7424b63b4d78d/LiquidRhino1.jpeg}>
  A before (*left*) and after (*right*) look at one of Dr. Rajagopal's liquid rhinoplasty patients.
</CaptionImg>

## **The Takeaway**
A liquid rhinoplasty may be a ‘lunchtime’ procedure, but there’s more to it than meets the eye. Like all injections, the provider should be thoroughly vetted and the patient should go in with realistic expectations. While it can improve nose shape and contour, not every aesthetic concern can be addressed sans surgery. A consultation with a board certified plastic surgeon will help determine if you are an ideal candidate for liquid rhinoplasty. 

Aesthetics

Did you know that a liquid rhinoplasty can address certain functional concerns? And that’s not all this non-surgical treatment can offer.

What To Know About Non-Surgical Liquid Rhinoplasty, According To A Plastic Surgeon

5 Things You Should Know About Liquid Rhinoplasty

ernesto-norman-R5CX8XDQLV0-unsplash

A seemingly quick fix treatment that has caught on like wildfire, your social media feed may have you thinking that [under eye filler](https://aedit.com/procedure/under-eye-filler) is a universal solution for common aesthetic eye concerns. While the treatment can be very effective for the right candidate, it – like just about every other cosmetic procedure – is not for everyone. 

Until recently, under eye filler was an ‘off label’ (read: not approved by the United States Food and Drug Administration) use of hyaluronic acid-based dermal fillers. Earlier this year, the [FDA approved](https://aedit.com/aedition/fda-approves-juvederm-volbella-xc-under-eye-filler) Juvéderm® Volbella XC for the improvement of infraorbital hollows in adults over the age of 21. As part of this new indication, Allergan Aesthetics will be providing training programs, including how to assess facial anatomy holistically and the identification and management of [potential complications](https://aedit.com/aedition/guide-to-cosmetic-surgery-complications), to anyone who wishes to inject. This is because injecting the tear troughs and hollows beneath the orbital rim is not without risk.

Good under eye filler can be transformative, but it can be hard to get it right. Not everyone wielding a needle is well-versed in the procedure, and not everyone who thinks they want the procedure is actually a candidate. Here, we investigate the under eye filler craze and why it's not a singular solution for all under eye concerns.

## **How Under Eye Filler Works**
For some, under the eyes lives a slight depression in the skin that absorbs light rather than reflecting it. When darkness casts a shadow on this inner part of the eye, known as the tear trough, a crease between the upper cheek and the lower eyelid becomes evident. Most patients who desire under eye filler complain of a hollow, dark, tired-looking eye that does not seem to go away, no matter what [skincare they use](https://aedit.com/aedition/best-eye-serums-for-fine-lines-dark-circles-puffiness) or do or how much concealer they layer on.

Blame your genes and the natural aging process for the cause of shadowing under the eyes. “The tissue structures supporting the eyelids weaken from aging or genetics,” says [Michele Green, MD](https://aedit.com/provider/michele-green-md-34642), a board certified dermatologist in New York City. “This weakening causes a hollowness and sagging of the skin in the under eye area, but hyaluronic acid fillers replenish volume to the area.” Although remediation with fillers is a relatively quick process, the procedure relies on dermal fillers placed into the deep hollows to replenish lost volume. Putting HA filler into deep under eye creases plumps them up so that the skin is smoother and can reflect light properly.

That, in turn, addresses more than just the tear trough. Injections can also help alleviate dark circles, which sometimes develop from volume loss in the lower eyelid fat pads, creating hollows, explains [Snehal Amin, MD](https://aedit.com/provider/snehal-amin-md-308), an NYC-based  board certified dermatologist. “By correcting underlying volume loss, shadows under the eye reduce,” he shares. “Volbella is FDA-approved for this indication, but it is imperative to seek out an experienced, qualified provider.”

Well-injected filler under the thin skin of the eyes are a great way to brighten up the eyes and reduce hollowness and that tired appearance from some of the tissues underneath the eye, says [Usha Rajagopal, MD](https://aedit.com/provider/usha-rajagopal-md-1330), a board certified plastic and reconstructive surgeon in San Francisco. She adds that smoothing out the grooves under the eye helps to improve the overall contour of the lower eyelid and, secondarily, reduce discoloration.

Since not all discoloration is an effect of shadowing and hollowing, it is crucial to identify the cause of discoloration before jumping into the under eye filler pool. For example, Dr. Amin says discoloration under the eyes can also be caused by rubbing the skin in cases of [eczema](https://aedit.com/aedition/comparing-eczema-vs-psoriasis) or allergies. And, for this type of darkness, filler isn't the answer. “Instead, [chemical peels](https://aedit.com/aedition/guide-to-superficial-medium-deep-chemical-peels) or [lasers](https://aedit.com/aedition/guide-to-ablative-laser-skin-resurfacing) best address this discoloration,” he says. 

With no downtime, the effects of under eye injections using hyaluronic acid-based filler are immediate (save for some minimal and typical [bruising](https://aedit.com/aedition/how-to-treat-prevent-bruising-after-lasers-filler-botox) and swelling). Within minutes of injecting the under eyes, patients can see a smoothness to the area, less darkness, and no more shadowing. The results generally last about a year.

## **Choose Your Injector Wisely**
This is where it starts to get a little dicey. The array of providers offering under eye filler treatment ranges from board certified dermatologists and plastic surgeons to your strip mall med-spa injector. And because those who don't hold a medical degree or have years of experience don't know the pitfalls of injections around the eye or facial anatomy, you may be putting yourself in a dangerous position by not going to a qualified provider. “The success of under eye fillers is not solely dependent upon the product used, but also the skills of the injector, their experience, and their comfort level using the filler product,” Dr. Green says. “There is an increased risk for developing unwanted side effects when performing injections with an inexperienced or unqualified injector.” 

All filler should be injected by a highly trained provider, but the under eye presents its own unique set of challenges. “This is not a med-spa procedure,” Dr. Amin cautions. “This is a medical procedure because of the complexity of the anatomy and the dangers of complications.” Additionally, the injector must be able to suss out who is a candidate and [manage expectations](https://aedit.com/aedition/how-plastic-surgeons-balance-patients-cosmetic-surgery-desires-and-safety) accordingly. For example, filler is an acceptable treatment option when a patient has a bothersome hollowness without large under eye bags, says [Jonathan Cabin, MD](https://aedit.com/provider/jonathan-cabin-md-956), a double board certified facial plastic and reconstructive surgeon in Arlington, VA. However, the addition of filler to bulging under eye bags (caused by protruding or displaced fat pads) will not do much of anything to correct the hollowness. “Patients must have realistic expectations of what can and cannot be corrected with filler and understand that filler will not improve wrinkles or primary dark circles,” Dr. Cabin explains. 

In most cases, filler cannot correct excess skin or [pigmentation-related](https://aedit.com/aedition/under-eye-hyperpigmentation) color changes to the skin. Also, people with fluctuating lower lid and mid-cheek swelling (known as malar edema) are usually not fit for filler treatment since injections can exacerbate this condition.

## **The Issues with Under Eye Filler**
Under eye filler is tricky because, as Dr. Rajagopal explains, volume deficits under the eye exist in many layers. “It can be deep and right next to the bone, just above the bone, or in the muscle layer or the skin layer,” she shares. “All these areas may need to be addressed differently in different patients.” Generally, the deeper the injection, the less visible the product. Furthermore, doctors must use a very thin filler in patients who require more superficial placement. If not, lumps, bumps, and even discoloration (i.e. the infamous blue tint) can ensue.

The most important takeaway with under eye fillers is that less is more. “A tiny amount of filler goes a long way,” Dr. Rajagopal says. “And the result should be an improvement of the area and not full correction because full correction leads to overcorrection, [overfilling](https://aedit.com/aedition/how-to-correct-overfilled-facial-features), a lumpy look, and often swelling underneath the eye.” It is important to remember that it is entirely normal to have mild depressions and some lines under the eyes. Attempting to eradicate them with too much smoothness can lead to an unnatural look.  

Overcorrection is, unfortunately, a common mistake. It creates less distinction between the cheek and the tear trough, which causes the eye to get smaller from above, says [Doris Day, MD](https://dorisdaymd.com/), a board certified dermatologist in NYC. Too much filler makes the eyes appear small and squinty and, conversely, the cheeks look disproportionately big. “When you keep filling and adding layers, the eyes can look off-balance,” she explains. “Instead, the eyes may require opening and the skin may need some tightening, but the key is not to erase those points of distinction.” When you do, “the face looks distorted, and it's a look that everyone is walking around with,” she adds.

But the aesthetic concerns related to overfilling are just the half of it. There are also more serious issues to be aware of, including:

- **Swelling**: Mild swelling for 24 to 48 hours after treatment is to be expected, but long-term [swelling](https://aedit.com/aedition/how-to-treat-minimize-swelling-after-cosmetic-surgery) that never goes away can occur. Patients with poor lymphatic drainage tend to hold onto more water and fluid in the eye area, so the addition of HA filler (which attracts water to plump) causes lasting fluid retention. Since certain fillers are more hydrophilic (meaning it holds onto water) than others, this presents the potential for the filler to puff a bit. Dr. Green adds that patients who present with bulging from water retention or sagging skin due to loss of elasticity should avoid under eye filler. 
- **Filler Migration**: Filler that moves under the eyes isn't atypical. As Dr. Day explains, migration partially occurs because of constant movement in the area and ligaments that push the filler around a bit. When filler migrates, it can shift downwards or to the side and even take on a bumpy or lumpy appearance depending on the filler used and how much of it there is. “Sometimes, we don't see the effects for months or even years later,” she notes.
- **Visible Product**: Known as the Tyndall effect, a bluish tint to the skin can occur from placing the filler too close to the surface of the skin. Some fillers are more prone to this than others. “I prefer using [Belotero®](https://aedit.com/procedure/belotero) for the tear troughs because there is no Tyndall effect,” Dr. Amin says. Although this discoloration can technically happen in any area of filler used, Dr. Cabin says it is most commonly seen under the eyes because the skin is fragile. However, he adds that your provider can prevent the Tyndall effect by injecting filler in the deeper areas (over bone) and only injecting small amounts per injection while keeping the cannula moving.
- **Vascular Occlusion**: One of the more severe complications that can arise, [vascular occlusion](https://aedit.com/aedition/risk-of-vascular-occlusion-after-dermal-filler) refers to accidentally injecting into an artery. When not immediately corrected (via HA-dissolving [hyaluronidase injections](https://aedit.com/procedure/hyaluronidase)), an occlusion can result in skin necrosis or skin death. While vascular occlusion and necrosis are rare, they do happen. Injection techniques that involve a pulling-back effect are critical, as is the correct type of injection tool (more on that below).
- **Blindness**: Blindness from filler injections is the most serious byproduct of an occlusion or blood clot that arises and blocks the typical blood flow pattern throughout and around the eyes. It's crucial to understand facial anatomy when injecting this area because there are far more blood vessels around the eye than other areas in the face. Although blindness from under eye fillers is the rarest complication, it is nothing to take lightly. A 2015 [study](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6554164/) found 98 cases of blindness related to the use of filler.

Your injector should use only [hyaluronic acid-based filler](https://aedit.com/aedition/hyaluronic-acid-filler-vs-biostimulatory-injectables) under the eyes. “Non-hyaluronic acid fillers, like [Sculptra®](https://aedit.com/procedure/sculptra) and [Radiesse®](https://aedit.com/procedure/radiesse), are too thick for this area,” Dr. Cabin says. "Also, Sculptra® and Radiesse® work over time by stimulating the body's collagen creation mechanisms, and movement around the eye can create irregularities as these fillers settle in.” While lumpiness as a result of HA filler is dissolvable with hyaluronidase, biostimulatory injectables are not reversible.

## **The Right Way to Inject Under the Eyes**
When injecting under the eyes, your injector has the choice between two different tools to prevent less-than-ideal results and complications: a [blunt-tipped cannula](https://aedit.com/aedition/guide-to-injectable-techniques-needles-for-botox-filler) (a soft plastic catheter that cannot interrupt a vessel) or a [needle](https://aedit.com/aedition/guide-to-needles-used-for-cosmetic-injectables-botox-filler). Both have their place, and it's up to your provider to choose the best one.

“The use of a blunt-tipped cannula to access the treatment area from below and just to the side of the lower eyelid is the gold standard for under eye treatment,” Dr. Cabin says. It nearly eliminates the risk of [bruising](https://aedit.com/aedition/how-to-treat-prevent-bruising-after-lasers-filler-botox), significantly reduces post-injection swelling, and also dramatically lessens the chance of a rare complication by preventing entry into the veins or arteries around the eye. “With all filler injections, injecting small aliquots while actively withdrawing the cannula helps reduce the risk of lumping or clumping and vascular or lymphatic disruption,” he adds.

All you have to do is think of how many times a day you blink to know the under eyes are an area of movement. They're anatomically complex, thin, and delicate, with an intricate network of several blood vessels and lymphatic drainage pathways. This makes filler placement more taxing than other parts of the face. “Therefore, under eye filler needs to be placed deep, just over the bone (periosteal), to be in an area that corrects the hollowness without causing any injury or disruption to the delicate structures of the under eye,” Dr. Cabin explains. “Placing the filler in a deep plane, just under the bone, also minimizes the risk of filler migration over time and will lower the risk of the Tyndall effect.”

Perhaps the best way to ensure good results (in addition to seeing a board certified dermatologist or plastic surgeon) is to make sure your injector has a deep understanding of facial anatomy, especially the periorbital area. “Many doctors inject filler as they withdraw the needle out of the skin; in other words, they push the plunger on the syringe as they pull the syringe backward,” Dr. Amin says. This technique prevents cannulation of blood vessels and limits the risk of intravascular filler injections.

## **Taking a Holistic Approach**
The features of the face live in [harmony](https://aedit.com/aedition/facial-harmony-in-aesthetic-medicine), not isolation. To ensure that the under eyes look natural and not artificially augmented, Dr. Rajagopal says to look at the face as a whole. “When you look at a beautiful face, it's the entire face,” she shares. “Generally, not just one area makes someone beautiful, but rather a complement of how one area flatters the other.” Selectively filling the under eye and failing to treat the surrounding areas, like the [cheeks](https://aedit.com/aedition/cosmetic-procedures-to-define-cheekbones), isn't usually the best approach. “Often, the eyelid-cheek conjunction is in continuity,” she shares. “So, to give the best results, it's important to inject part of the cheek along with the lower lid.”

A higher cheekbone or zygoma will pull the skin taught under the eyes. “Your doctor can inject filler into the cheek area to improve the under eye area,” Dr. Amin says. Plus, injecting directly into the cheeks instead of under the eyelids is safer. “Filler placement in the cheeks lasts a lot longer than the fillers used in the periorbital area,” he adds. Beyond the cheeks, the [temples](https://aedit.com/aedition/cosmetic-forehead-procedures) also need to be considered. 

Sometimes, addressing the neighboring features is all it takes to create the effect of more refreshed eyes. “That’s why I address everywhere around the eyes before correcting them because it may just be an adjustment to the cheeks or brows that a patient needs instead,” Dr. Day says.

## **Does the Recent FDA Approval Change Anything?**
As we mentioned, under eye filler was an off-label use (meaning it did not hold an FDA-approved indication) until the recent approval of Juvéderm® Volbella XC. “Volbella is a hyaluronic acid dermal filler with an innovative combination of low and high molecular weight technology, which improves the cross-linking efficiency of the hyaluronic acid chains,” Dr. Green explains. “In addition, this new Vycross technology delivers an ultra-smooth gel that is malleable, which results in a natural look and feel to improve the appearance of under eye bags.”

However, just because there’s now an FDA-approved filler for use under the eyes doesn’t equate to every dermatologist and plastic surgeon jumping on the Juvéderm® Volbella XC bandwagon. Some physicians, including Dr. Day, do not use like to use it under the eyes. “In general, I think it’s a problematic product,” she explains. “It can be somewhat unpredictable, and Juvéderm® tends to swell under the eyes.” While she concedes that the data from Juvéderm® Volbella XC “doesn’t show issues with it,” she prefers [Restylane®](https://aedit.com/procedure/restylane) and Belotero® for correcting under eye hollows.

So, does a new FDA indication mean that everything we know about under eye filler and its safety go entirely out the window? No. Like all aesthetic treatments, patients must weigh risk and reward. Dr. Cabin says whether a treatment or specific product is categorized as on-label or off-label has very little to do with safety and efficacy. “Receiving FDA approval is a very complicated and expensive process that can take years, so some filler manufacturers have to decide which on-label indications to pursue given these constraints,” he explains. “When a filler (or other aesthetic treatments) is not on-label, it doesn't mean they are less effective or more dangerous.”

Dermatologists and plastic surgeons weigh in on why the popular procedure isn’t for everyone.

The Pros And Cons Of Under Eye Filler

The Truth About Under Eye Filler

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We’ve heard of [lip filler](https://aedit.com/procedure/temporary-lip-fillers), [cheek filler](https://aedit.com/procedure/cheek-augmentation-with-fillers), and even [hand filler](https://aedit.com/procedure/hand-rejuvenation-with-dermal-fillers), but it wasn’t until recently that the notion of foot filler crossed our desks. Just because it may not enjoy the same notoriety, however, does not mean it lacks a fan base. “A fair number of people do it,” says [Darren Smith, MD](https://www.darrensmithmd.com/), a board certified plastic and reconstructive surgeon in New York City. “It just doesn’t come up in conversation.” 

To change that, we spoke to two physicians familiar with foot injections — which, keep in mind, isn’t necessarily all dermatologists or plastic surgeons — to learn more about the benefits of injecting filler into the feet for both cosmetic and functional benefits.

## **The Aesthetic Benefits of Foot Filler**
[Dermal fillers](https://aedit.com/procedure/dermal-filler-and-injectable-solutions) can be used to shape features from head to toe – quite literally. The same fillers you put in your face to restore lost volume and contour can be injected into your feet for both cosmetic and functional purposes, Dr. Smith says.

If aesthetics are your concern, you’re likely going to be treating the [tops of the feet](https://aedit.com/aedition/cosmetic-treatments-procedures-for-feet-nails-toes). “Loss of volume in many different parts of the body connotes aging, and the feet are no different,” Dr. Smith explains. “Some people think their veins are too visible or their tendons are too visible.” While this is a natural part of the aging process for many, it can also be exacerbated by certain otherwise healthy lifestyle habits. It’s fairly common for people who work out regularly to lose fat on their feet (sadly, your running regimen doesn’t just make you choose between your ass and your face), which can make tendons appear more visible over time. 

Similar to using filler to rejuvenate [aging hands](https://aedit.com/aedition/aesthetic-treatments-for-aging-hands), injecting hyaluronic acid (HA)-based fillers, such as [Juvéderm®](https://aedit.com/procedure/juvederm) or [Belotero®](https://aedit.com/procedure/belotero), into the top of the foot can camouflage bulging veins or tendons and add volume. As with most HA filler injections, the results last six to nine months before it’s time for a touch up.

## **The Functional Benefits of Foot Filler**
Sure, cosmetic foot filler can be a confidence-booster for those of us who are insecure about our feet. But the real game-changing use of injectables is functional. [Neil Sadick, MD](https://sadickdermatology.com/), a board certified cosmetic dermatologist in NYC and the founder of [Stride](https://getmystride.com/), recommends foot filler for patients — typically ones who’ve been referred by a podiatrist — who have pain when they walk. Think of the filler as an in-sole that you just so happen to be inserting into your own foot.

For patients who come to Dr. Sadick with plantar fasciitis, calluses around the foot, or thickening of the heels, filler can act as a cushion to the area and lead to less mechanical trauma from the regular act of walking on two feet. Dr. Smith agrees. “If you look at a cross section of a foot, you should have a nice little pillow of fat at the soul of your forefoot and the soul of your hind foot,” he shares. “There are people with genetic reasons or repetitive use reasons — some people think if you spend a lot of time walking around barefoot, for example — where those fat pads, which should serve as shock absorbers, atrophy or shrink over time.” 

In such cases, it becomes very painful to walk, and that’s where your injector can come in and help you recreate the natural cushion that has been lost. HA fillers can be employed for this purpose ([studies show](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6039379/) HA filler injections under the metatarsal heads can provide a “significant and long-lasting improvement” in treating metatarsalgia – a condition in which the ball of the foot becomes painful and inflamed – caused by wearing high heels), Dr. Smith likes biostimulatory injectables, like [Radiesse®](https://aedit.com/procedure/radiesse) and [Sculptra®](https://aedit.com/procedure/sculptra), for functional improvement. The former is made of calcium hydroxylapatite (CAHA) and the latter of poly-L-lactic acid (PLLA), which both stimulate natural collagen production in the body for a longer-term effect.

Depending on the patient, fat grafting may also be an option. Dr. Smith says he works closely with podiatrists to address functional foot issues with [fat transfer](https://aedit.com/aedition/why-everyone-is-talking-about-fat-grafting), which involves liposuctioning fat from a donor site (think: the flanks or thighs), purifying it, and injecting it into the feet. After an initial reabsorption period, the transferred fat is permanent. 

## **The Takeaway**
The feet may not be the flashiest place to inject filler, but strategic placement of [HA and biostimulatory injectables](https://aedit.com/aedition/hyaluronic-acid-filler-vs-biostimulatory-injectables) can be transformative for those who experience certain kinds of foot pain or those with aesthetic concerns about their trotters. If you’re interested in foot filler, start with a visit to a board certified cosmetic dermatologist or plastic surgeon who has experience injecting in this area. “There’s lots of important stuff in the foot,” Dr. Smith cautions. A slip of the needle could lead to nerve problems, blown veins, or damaged tendons, all issues a practiced injector will know how to avoid. 

Hyaluronic acid-based filler and biostimulatory injectables can be used to treat foot pain and minimize aesthetic concerns on the tops of the feet.

The Functional And Cosmetic Benefits Of Foot Filler

Is Foot Filler Really A Thing?

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Given how much we all talk about the [under eye filler](https://aedit.com/procedure/under-eye-filler), it’s easy to assume that the treatment was already an indication approved by the United States Food and Drug Administration (FDA). But injecting the tear troughs to rejuvenate hollows and minimize the appearance of bags and dark circles has actually been an ‘off label’ use of hyaluronic acid (HA)-based filler. Not any more. 

On Tuesday, Allergan Aesthetics [announced](https://www.prnewswire.com/news-releases/fda-approves-juvederm-volbella-xc-for-undereye-hollows-301477144.html) the FDA approval of [Juvéderm® Volbella XC](https://aedit.com/procedure/juvederm) for improvement of infraorbital hollows in adults over the age of 21. “This additional indication… demonstrates Allergan Aesthetics' continued commitment to innovation,” Carrie Strom, president of Global Allergan Aesthetics and senior vice president of AbbVie, said in a press release. So, what does the news mean for your next filler appointment? Here’s what you need to know.

## **The Popularity of Under Eye Filler**
Under eye filler has risen in popularity over the last couple of years, especially as pandemic-related face coverings put more [emphasis on the eyes](https://aedit.com/aedition/popularity-of-eyelid-surgery-cosmetic-eye-procedures-during-covid-19) and the stress of everyday life made dark circles, well, darker. “The under eye area is one of the most frequently requested treatment sites among patients, regardless of race and ethnicity, but it is undertreated,” says [Julie Woodward, MD](https://www.dukehealth.org/find-doctors-physicians/julie-ann-woodward-md), a board certified oculofacial plastic surgeon and ophthalmologist and Allergan Medical Institute (AMI) trainer. “This is in part because it is a sensitive area to inject as it takes great skill and precision.”

The tear troughs are a very delicate area to treat and require [unique technique](https://aedit.com/aedition/guide-to-injectable-techniques-needles-for-botox-filler) from a highly skilled provider. This approval should help improve the safety and efficacy of the procedure.  Per an FDA requirement for this new indication, Allergan Aesthetics will provide training programs, including how to assess facial anatomy holistically and the identification and management of [potential complications](https://aedit.com/aedition/risk-of-vascular-occlusion-after-dermal-filler). Providers will need to complete this training before being allowed to inject Juvéderm® Volbella XC under the eyes. 

## **The Benefits of Under Eye Filler with Juvéderm Volbella XC**
Juvéderm® Volbella XC was first approved by the FDA in 2016 for use in the lips and perioral rhytids (a.k.a. the vertical lines that extend from the upper lip). What gives the product a natural look and feel for the lip area extends to the tear troughs. “The characteristics of Juvéderm® Volbella XC with lower amounts of hyaluronic acid molecules and low water affinity provides a soft, smooth formulation appropriate for treating under eye hollows,” Dr. Woodward explains.

Allergan Aesthetics reports that, according to clinical trial data, 90 percent of patients reported satisfaction through one year after treatment with Juvéderm® Volbella XC and said they would recommend the treatment to a friend. “The results of the clinical trial demonstrate significant improvements in the appearance of under eye hollows and overall appearance,” Dr. Woodward shares. “In addition, 80 percent of subjects reported they were a little or not at all bothered by how tired and old the under eye area looked at three months compared to 15 percent and 30 percent before treatment, respectively.”

## **Under Eye Filler Recovery & Results**
The majority of patients in the clinical trials experienced side effects such as injection site tenderness, [bruising](https://aedit.com/aedition/how-to-treat-prevent-bruising-after-lasers-filler-botox), swelling, lumps and bumps, redness, pain after injection, firmness, discoloration (other than redness or swelling), and/or itching. This data is based on patient reporting in their 30-day daily diaries. Allergan Aesthetics notes that a majority of these side effects were “mild in severity” and “easily tolerated” – though some subjects experienced mild swelling that lingered for more than 30 days post-treatment. One patient in that group required treatment with antibiotics (the rest did not require intervention), and all of these effects resolved by day 45.

The results of all hyaluronic acid-based fillers are [temporary](https://aedit.com/aedition/how-frequently-to-get-non-surgical-cosmetic-procedures-like-dermal-filler-botox-chemical-peel), and under eye filler is no exception. Based on the clinical studies, patients reported being satisfied with their results from Juvéderm® Volbella XC for at least 12 months.

Here’s what it means for your next injectable appointment.

FDA Approves Juvéderm Volbella XC For Under Eye Filler

The FDA Just Approved Under Eye Filler For The First Time

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In the hands of the wrong injector, fillers and injectables can be a [slippery slope](https://aedit.com/aedition/how-to-correct-overfilled-facial-features). Yet, the idea of [DIY, at-home](https://aedit.com/aedition/dangers-of-diy-at-home-dermatology-beauty-treatments) needleless methods to plump up limp lips is no alternative (the words ludicrous, unsafe, and downright senseless come to mind). Nevertheless, the troubling trend is all over TikTok and Instagram, pushing the talk of makeshift ‘injectables’ into the mainstream. But here’s the thing: The fact that you can purchase needle-free devices (a.k.a. hyaluron pens) online, doesn't mean you should – nor should you use them due to the mounting list of complications. “Just because something does not have a needle does not make it safe, effective, or good to perform at home,” says [Ava Shamban, MD](https://aedit.com/provider/ava-shamban-md-2325), a board certified dermatologist in Santa Monica, CA.

If you're looking to inject your lips or anywhere else on the face or body, a board certified provider who specializes in the treatment you are interested in is the only way to go. But, in case you need further convincing, we’re here to outline why hyaluron pens are never a good idea.

## **The Danger Zone**
Hyaluron pens are rapidly coming under fire — and have been for much of the past year — for their ability to augment the lips and other facial features unsafely. Marketed as do-it-yourself injections that replace the need for [hyaluronic acid (HA)-based dermal fillers](https://aedit.com/aedition/hyaluronic-acid-filler-vs-biostimulatory-injectables) legally procured and injected by medical professionals, providers have been trying to warn patients to stay away from these gadgets at all costs. Even the United States Food and Drug Administration (FDA) weighed in. Last fall, the agency [issued statements](https://www.fda.gov/medical-devices/safety-communications/do-not-use-needle-free-devices-injection-dermal-fillers-fda-safety-communication) cautioning both “the public and healthcare professionals not to use needle-free devices such as hyaluron pens for injection of hyaluronic acid or other lip and facial filler.” In theory, the idea of do-it-yourself-when-you-need-it injectables sound like a dream come true, but they're anything but that.

Needle-free devices go by a variety of names, including hyaluron pens, Hyla-Pen, microinjectors, non-invasive injection pens, non-invasive nebulizer syringes, high-pressure pens, and sprayer pens. These pressure-powered pens serve as a way for people with diabetes to safely administer daily insulin and deliver anything from vaccines to Cortisone. However, illegal hyaluron pens force hyaluronic acid and other unknown filling agents into the lips (or other facial features) creating a recipe for disaster.

Their accessibility makes hyaluron pens popular, but no at-home cosmetic procedure that entails supplies bought through Amazon is a good idea, says [Douglas Monasebian, MD](https://aedit.com/provider/douglas-monasebian-md-200), a New York City-based board certified plastic and maxillofacial surgeon and assistant professor at the Mount Sinai School of Medicine. “An individual should never perform do-it-yourself injections,” he explains. “When a board certified physician performs the procedure, the patient can rest assured that the product is safe, sterile, and certified.” Both [cannulas and needles](https://aedit.com/aedition/guide-to-injectable-techniques-needles-for-botox-filler) are safe injection techniques that allow the injector to place filler in specific planes and depths of tissue to achieve a desirable outcome safely, says [Snehal Amin, MD](https://aedit.com/provider/snehal-amin-md-308), a board certified dermatologist in New York City. So, without a needle, how does the assumed hyaluronic acid enter the lips in an attempt to make them look fuller? 

Unlike syringe-based injections performed by a professional, these dodgy devices use high pressure to force the filling product into the body. “Hyaluron pens work by an aerosolized air pressure that forces hyaluronic acid gel into the face, most commonly the lips,” explains Dr. Monasebian. “There are dangers associated with this as it would be difficult to control the amount of pressure that is exerted on the lips and also where it settles.” Whereas a needle or cannula allows for controlled injections of the filler exactly where desired, these hyaluron pens don't offer that mechanism because there's no ‘press’ via the plunger. This makes the treatment much harder to control and leads to far less predictable results.

Don’t let the naming convention fool you. Although these now-popular tools have the prefix of ‘hyaluron’ in their name, they don't contain hyaluronic acid – yet many users assume they do. Furthermore, they will not accomplish what you want them to, says Kenneth Beer, MD, a board certified dermatologist in West Palm Beach, FL, and founder of [Scientific Rx Skincare](https://scientificrx.com/). “I find them to be a waste of time and money,” he adds.

## **How Hyaluron Pens Became Trendy**
Blame the uptick of this scary treatment on the virality of social media coupled with COVID-issued stay-at-home orders back in March of 2020. “People interested in cosmetics and aesthetics respond positively to the words ‘non-invasive’ or ‘needle-free,’” Dr. Amin says. The marketers behind many needle-free devices imply that these pens are nearly equivalent to fillers administered by a dermatologist or plastic surgeon, which is far from the truth. “The only people one should listen to about the safety and effectiveness of medical procedures are the physicians who are doing these procedures — a layperson should never offer medical advice,” Dr. Monasebian says.

Unfortunately, most patients who opt for DIY fillers are not licensed or do not know what they are doing. “It is especially enticing to try these filler pens if you see it being done by your favorite YouTube star,” Dr. Amin shares. “The issues always are: it's not clear what someone is injecting; the location and depth of the injection are highly variable; and the injection is very superficial but can cause bruising, infections, and lumps.” When administered by a reputable provider, a syringe is precise, easily controlled, sterile, and guaranteed to have a safe, FDA-approved product within it. The same cannot be said for these needle-free tools. “It's like the difference between a toddler and an adult driving a car — one knows what they're doing, and the other is clueless,” Dr. Beer notes. 

A cheap (pens range in price from $50 to a few hundred dollars) and easy-to-get-your-hands-on alternative to professionally administered treatments, you can purchase hyaluron pens on a plethora of websites. But, as Dr. Beer says, there is no clear purpose of using hyaluron pens other than a shortcut to avoid injections and their cost. 

## **Doctors Are Up in Arms**
Hyaluron pens make dermatologists and plastic surgeons livid, and we don't blame them for being irate. Some beauty and anti-aging trends that surface on social media push for positive shifts and waves for professionals. Still, this one isn't. Dr. Shamban says the hyaluron pen trend is shocking and its substantial social media presence is quite scary. “There are tremendous risks for using a pneumatically-driven device to deliver potentially contaminated – with either an infectious agent or a chemical – product to the face,” she says. “Add to that it is administered by a non-medical professional, and there is likely to be a dermal disaster.”

Patients pay a premium for professional expertise, but it helps minimize the [risk of complications](https://aedit.com/aedition/guide-to-cosmetic-surgery-complications) (all elective cosmetic treatments and procedures carry some potential risk) and maximize the result. “In the office of a board certified dermatologist, you receive controlled injections by a highly skilled individual using a product that is manufactured according to FDA specifications, which includes a safety profile,” Dr. Shamban shares. Plus, patients are also dolling out their hard-earned cash for their doctor's experience in artistry and their ability to intervene, manage, and mitigate any reactions or problems that may arise. But with hyaluron pens, none of that exists. “It looks simple, and it appears to be a quick fix that anyone can do because it does not engage a needle, but it's not an inexpensive way to plump at will,” she adds.

## **What Can Go Wrong with Hyaluron Pens**
Besides the fact that hyaluron pen injections are far from pain-free as many users on social media claim them to be, there's a slew of potential problems that can quickly arise. Dr. Shamban cautions patients to be extremely wary about performing these treatments on themselves or having the device used by a non-medical professional. “It is taking a major risk with innumerable complications, particularly in the wrong hands,” she says. “Risk to reward will never be worth it, and there's documentation of countless medical issues with these devices.”

Suppose using a pen results in adverse effects. In that case, it's not as easy of a fix as injecting some [hyaluronidase](https://aedit.com/procedure/hyaluronidase) (an enzyme that dissolves hyaluronic acid) and waiting for the filler to vanish. There's also the risk of permanent complications and possible disfigurement. Plus, Dr. Monasebian says patients do not know the delicate anatomy of the face, and this is how and why complications occur. All of that adds up to a high probability of something going wrong. Such adverse effects include:

- **It places filler in the wrong area.** There's usually a lack of facial anatomy and medical experience among hyaluron pen users, making it super easy to administer the filler into the wrong area. “Hyaluron pens merely ‘push’ a thin hyaluronic acid filler into the dermis (a superficial layer of tissue) where it disperses in a nondescript fashion,” Dr. Amin says. “Lacking specificity, it is much less likely to produce an aesthetically pleasing result.” There are vessels and nerves in the face, and, if someone does not know where they are, they can easily get the product into the wrong area.
- **The pressure can cause issues.** Since pressure is the method of product disbursement here, a bevy of severe problems can quickly ensue, including skin necrosis, long-term [swelling](https://aedit.com/aedition/how-to-treat-minimize-swelling-after-cosmetic-surgery) and [bruising](https://aedit.com/aedition/how-to-treat-prevent-bruising-after-lasers-filler-botox), blocked blood vessels, and hard-to-fix lumpiness. As Dr. Shamban says, “operator error is just one aspect of the problem.”
- **Duck lips are pretty much to be expected.** The only way to fix them is with [hyaluronidase](https://aedit.com/aedition/hyaluronidase-to-dissolve-dermal-filler), an injectable enzyme that deflates the area treated with hyaluronic acid by breaking it up.
- **Reports of infections exist.** Any dermatologist, plastic surgeon, or certified injector knows that it's a sin to inject the lips – or any other facial feature – without thoroughly cleaning them first. However, most at-home users don't follow the proper and necessary protocols to sterilize an area, making it prone to infection. “High pressure can also deposit bacteria, which can lead to infections,” Dr. Beer explains. “The problem is that these infections can be from bizarre types of bacteria.”
- **Vascular occlusions can occur.** Perhaps the most serious complication is [vascular occlusion](https://aedit.com/aedition/risk-of-vascular-occlusion-after-dermal-filler), which occurs when an injectable gel or substance enters an artery and limits blood flow, possibly leading to skin loss, blindness, or stroke. Of course, any filler poses the potential for this, which is why dermatologists constantly stress the importance of only seeing a board certified, experienced injector. There's also misinformation swirling around out there that says that these pens can't cause a vascular accident, which is not the case.
- **Asymmetries and bumps are common.** We've already explained the rule of predictability and understanding of facial anatomy. Without either of those, there's no way to ensure a smooth, successful result. Also, the force and pressure used to insert filler into the face cause the product to spread uncontrollably, resulting in [asymmetries](https://aedit.com/aedition/cosmetic-procedures-for-body-asymmetries) of some sort. On the other hand, not depositing the filler deep enough can lead to lumps, bumps, and even a blue tint on the skin.

## **The HA Factor**
As if the concept of performing your injectables with a non-FDA-approved device isn't scary enough, it's important to shed light on what's inside these tools. Unlike in-office, doctor-administered treatments that use hyaluron pens under a prescription for entirely different (read: non-aesthetic) purposes, these pens almost never use the same quality filler as what professionals inject. Most times, what goes into the pen is equally as frightening, if not more so than the act of self-injecting.

So, where do the products that everyone is putting into their pens come from? No one knows, to be honest. “It can be anything from water to Jell-O or counterfeit fillers, which are a large-scale problem as recently [reported in a study](https://journals.lww.com/dermatologicsurgery/Citation/9000/Cross_Sectional_Study_of_Hyaluron_Pens_Posted_on.97306.aspx) published in the *Journal Dermatologic Surgery*,” Dr. Amin says. Another [article](https://www.jaad.org/article/S0190-96222030285-1/fulltext) in the *Journal of the American Academy of Dermatology* references the rise in unregulated internet injectables and the growing trend of self-injecting unregulated neurotoxins and fillers under the guidance of YouTube tutorials. “So there's a lot of concern about what people are putting into these pens,” he adds.

Often, most hyaluron pens are sold separately from the ‘filler,’ making it hard for consumers to know what they're injecting into their faces. Not knowing what lives within a patient’s face can make it downright impossible to properly correct an issue – especially if the product is contaminated. “Sometimes, you can have a lifelong complication of a very difficult-to-treat fungal infection or even a foreign body reaction that ultimately will result in a lot of scarring,” Dr. Shamban warns.

## **The Takeaway** 
If fuller lips, more defined cheeks, or smoother wrinkles are on your [goal list for 2022](https://aedit.com/aedition/biggest-medical-aesthetics-trends-of-2022-for-face-body), do yourself a favor and visit a [board certified](https://aedit.com/aedition/finding-the-right-plastic-surgeon-dermatologist-or-cosmetic-dentist) dermatologist or plastic surgeon rather than taking matters into your own hands with a hyaluron pen.

Doctors warn against the self-injection trend.

The AEDITION

Dermal Fillers