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Hyaluronic acid (trade name Restylane) is a natural tissue component that has gained popularity in recent years as an injectable product for restoring facial volume and treating deep wrinkles. It is a totally safe product that has other applications in medicine besides cosmetics, it is used in cataract surgery and in some cases of arthrosis as a joint lubricant.
Treatment of dark circles under the eyes with hyaluronic acid has become an increasingly popular treatment for patients in the third, fourth and fifth decades of life. At this age, there is often a loss of volume in the furrow of the ear, which makes it more pronounced. When we have a marked groove of the eyebrow but no bags in the eyelids, there is no surgical treatment that can solve it since the main problem is the loss of volume. When on the contrary we have the groove together with fat bags, we can redistribute that fat tissue to eliminate the groove.
In many patients, in addition to the furrow, a dark color appears under the eyes. In some patients this is simply due to a shadow effect, so after treatment you will get better. In other patients there is a real pigmentation of that area, which will not improve withhyaluronic acid.
Hyaluronic acid is a great option for treating dark circles under the eyes. It is injected deep, under the skin and muscle to avoid visible nodules and achieve a uniform result. Dark circles under the eyes improve in many patients. Hyaluronic acid treatment in the office is performed under topical anesthesia (cream) and the effect is immediate. Sometimes a little purple can appear in the area. The patient can return to normal activity the same day.
These wipes are prepared with a mild soap specially designed for this problem. An alternative to these products is to use baby soap cut in half with water and on a soft cloth. Daily palpebral hygiene, carried out on a daily basis, can provide effective and lasting control of your symptoms in the medium term. Palpebral hygiene is also performed today in the ophthalmologist’s office. Through the use of devices such as BlephEx, the edge of the eyelids can be cleaned very effectively, uncovering the Meibomio glands that have been blocked and with immediate symptomatic improvement on the part of the patient. Antibiotic ointments (with or without cortisone) are sometimes indicated for short periods of time if bacterial overgrowth is considered to exist. Treatment with oral doxycycline (antibiotic) can be very effective in certain types of blepharitis. Not because of its antibiotic properties but because of its modulating properties of the Meibomio glands. Nutritional supplements with antioxidants, vitamins and Omega 3 and 6 essential fatty acids have an increasingly proven role in the treatment of blepharitis, as they can improve the functioning of the Meibomian glands.
Hyaluronic acid is slowly reabsorbed by the body but can be reinjected over time if deemed necessary. Treatment needs to be non-permanent, as the patient’s anatomical characteristics will change over the years and may require another type of treatment.
Treatment with hyaluronic acid is reversible. This means that if the patient is not happy with the result, a substance can be applied that dissolves the hyaluronic acid within hours, returning it to its initial situation.
Hyaluronic acid is also used in the treatment of established skin wrinkles, not expression wrinkles (for the latter we use botulinum toxin) It can be used between the eyebrows, on crow’s feet, in the jaw area, etc… Sometimes we use it in combination with botulinum toxin, for example in deep wrinkles between the eyebrows that cannot be completely improved by botox alone.
For deep folds such as nasojugal folds or marionette lines, or for cheekbone augmentation, we use another product different from hyaluronic acid: it is calcium hydroxyapatite (trade name Radiesse). This is a much more consistent product than hyaluronic acid, so it cannot be used to treat surface wrinkles. It is ideal for deep folds and for increasing cheekbone volume, as it is injected into deeper areas and has a much longer duration than hyaluronic acid. In addition, this product promotes the formation of collagen in the injected area, so once reabsorbed the product will persist part of its effect.
Dr. Nieto is a reference in oculoplastic surgery. He combines his activity in reconstructive surgery in public medicine with his private reconstructive and cosmetic activity at the Clínica Corachán in Barcelonaand the Instituto Oftalmólogico Gabriel Simón in Madrid.
Clínica Corachán 2, bajos. Plaza Manuel Corachán 4, Despacho 8 Barcelona 08017
Instituto Oftalmológico Gabriel Simón Fuencarral, 7 28004-Madrid
