Filler Details

How much Restylane® you need very much depends on your facial anatomy. The key is a personal assessment by Dr. Steinsapir. At the time of the visit, Dr. Steinsapir will assess you and tell you the necessary volume. Our best advice is to get full correction.

Most patients with average dark circles need about 1 ml of Restylane® under each eye. However, you may need more or less. When financial considerations are an issue, Dr. Steinsapir will work with you to get the most from the treatment you are able to afford. Before you agree to service, we will be able to give you a precise quote once Dr. Steinsapir has personally assessed you.

Our office believes in providing a very high level of boutique care. All patients are seen and all services are performed by Dr. Steinsapir, who believes in natural results. Dr. Steinsapir approaches each patient as an individual. This means a detailed history, careful listening to individual concerns and developing a plan that works for the individual based on their needs.

One of the most important things to understand about the under eye circle is how thin the eyelid is in this region. On the cheek, there is more flexibility in the choice of fillers because lumps and bumps can and do hide out in the cheek fat. There is not such a margin for error in the lower eyelid. Therefore it is essential to work with a filler that is easily adjusted after the treatment should this be necessary. Permanent fillers lack this flexibility. For example, surgery may be needed if a lump is seen after treatment with your own fat or a filler like Artefill® or silicone oil. Even fillers like Radiesse® and Sculptra® have been reported to produce irregularities visible at the skin surface making them a less than ideal choice for this particular application.

Dr. Steinsapir thinks that Juvederm®, which is also a sugar gel filler, is an excellent product. However, you may be aware from Allergan, Inc. (the company that makes Juvederm®) marketing that it is touted as being “smooth.” Indeed, there are slight flow characteristics that differ between Juvederm® and Restylane®. Dr. Steinsapir finds that the relative “thickness” or viscosity of the Restylane® actually makes it easier to work with for the under eye area. It is Dr. Steinsapir’s personal opinion that the higher viscosity of the Restylane® helps keep the material in place in the tissues of the lower eyelid/cheek interface. In fairness, both materials seem to last about the same amount of time and both can be adjusted if needed at any time after they have been placed.

Restylane Lyft® is distributed by Galderma, the company responsible for Restylane®. Restylane Lyft® is a thicker material than Restylane® and seems to last a few months longer than Restylane®. This time frame seems to be well over a year, which is amazing. The material is fantastic for volumizing the face including the cheeks, eyebrow, chin, and perioral area. Again, these areas have much more fat to work with than the lower eyelid dark circle. Restylane Lyft® is commonly used in the top of the cheek to compliment the Restylane® volume used in the dark circle/lower eyelid hollow.

Restylane® appears to be quite long lasting with many patients reporting treatment benefits over a year. The key to long-term happiness is getting enough volume replacement with the initial treatment.

This is a testament to how long Restylane® can last. Not all treatments are equal. The material is being used to sculpt your face. You need someone who really understands the anatomy and how to best place the material. You may be surprised to learn that many Medi-Spas are actually illegal businesses. In California, the Medical Board required that a doctor be on the premises and perform a good faith examination before a nurse can treat you. It is not sufficient that a doctor serve in the capacity of “medical director” with no actual physical presence. Just say no if your aesthetician wants to come at you with a needle. The good news is that the bluish streak, which represents very superficial Restylane®, can easily be removed with a tiny nick in the skin or by injection with an enzyme, hyaluronidase, that breaks the product down.

If you don’t bruise, there is about 30-40 hours of mild swelling following the treatment. Women and men who use camouflage makeup can usually hide this swelling within hours of treatment. Now let’s talk about bruising. The incidence of bruising is about 20%. The nature of the bruise varies from a little micro-bruise that will disappear in about 2-3 days to a major shiner. The incidence of a black eye is about 2%-a small incidence unless you are the one who gets the black eye. Black eyes can take 2-3 weeks to fully resolve. Think of the procedure as surgery in a syringe.

Certain medicines thin the blood, which is to say they promote bruising. Aspirin, Motrin®, its generic form ibuprofen, and virtually all non-steroidal anti-inflammatory agents increase the risk of bruising. Almost anything herbal may contain natural products that can increase the risk of bruising. Red wine can do the same. Normally these are healthy for us. However, to minimize the risk of having a bruise, it is advisable to avoid these types of products for about 10 days before a treatment. If you are not sure if a product you use on a regular basis promotes bruising, call the office and we can address this issue for you.

If you are taking a medication prescribed by your doctor specifically to promote anti-coagulation like Coumadin®, Plavix®, or even aspirin; don’t stop these medications without consulting the doctor who prescribed them. If you are serious about treatment, we advise a consultation with Dr. Steinsapir. He will assess your cosmetic needs and help balance them against your health issues. If treatment makes sense, it may be more reasonable to risk a bruise than to stop these medications.