A short procedural video transcript showing Drs. performing Restylane (hyaluronic acid) injections into the lower eyelid tear troughs to reduce dark circles. The speakers explain causes of periorbital dark circles, demonstrate an injection technique (deep, on‑bone, small boluses), describe immediate effects and common bruising/swelling, and note durability (~almost a year).
Chapters
Hi. Today we're going to do some injections to the tear troughs.
The tear trough is essentially the area under the eyelids, and a lot of.
People have this little depression, and it.
Creates what's called dark circles.
Now, there's many different reasons for dark.
Circles under the eyes. Sometimes there's hyperpigmentation under the eyes. Sometimes there's actually discoloration through the thin skin. You can actually see the purplish brown muscle through the skin, creating the dark circles. And a lot of times you can actually have eyelid bags that create a shadow under them. But one of the most common reasons for dark circles is when the cheekbone area that corresponds to the inferior orbital rim, which is the bottom part of the bony eye socket, is weaker and it's underdeveloped.
So what we do is, is we.
Fill this area with either fat or fillers. And essentially what it creates is a slight little fullness, and it fills in the area nicely. And then makeup is much easier to cover. The lower eyelid area. At the end of the day, makeup is one of the easiest things to do. For the lower eyelids, however, you have to correct that contour so you can use makeup easier. I prefer Restylane, although Juvederm can also be done for the lower eyelid area. Restylane has a little bit more firmness and structural lift compared to Juvederm, and it creates less of a baggy look.
So we're going to do that injection.
I've applied a little bit of topical numbing for about 10 minutes. That's really all that's necessary.
I'm going to show you the injection technique now. So we're going to take the needle and we're going to go straight down, all the way down to the bone, and we're just going to put a little bit right there under the bone, and I'm going to push it, and it just melts away nicely. And we're going to walk this up, up and down the bone. They're just tiny little blebs. Push it away, and that's really it. Is this hurting real bad? How are you feeling?
I feel no pain.
Not too bad. Probably a little startling being around your eyes, but more so. It's just the thought of getting the injections under the eyes more so than the pain. Actually, this filler, the Restylane, actually has lidocaine in it. So as we start injecting and we start going, she's going to start feeling numbness little by little anyway, so. So when you go back and Contour that area again for a second injection row. It'll be a lot more comfortable. And you can see right there immediately how it's lifted up. What I'm going to do is I'm going to leave that side alone so the numbing starts working. And we're going to go to the other side. You're doing great. This one's comfortable?
Yes.
Okay, there's again, just inject, press. What's really important is to inject right on top of the bone. You don't want to be into the muscle, into the skin, into the fat, Because then you create lumpy, bumpy appearance. What we're trying to do is we're trying to build up the bone. This was approaching that area that she was sensitive on the other side. I'm feeling where the orbital rim is. And just put an injection right there. You're always feeling with your hand, you're always injecting away from the eye. That's it. And while bleeding and bruising can be common, because the muscle that covers this area is very vascular, it actually is surprisingly not that bad for most people. Now, once in a while, people will bleed and bruise significantly, almost like surgery. But most patients just get a little bit of yellowness or green hue of a bruise. Nothing too terrible. Okay, so when I have you hold this pressure here for a second. Good. It takes it a few days to get a really nice contour. Initially, each of these injections will have a little bit of swelling just around where the needle went in. And then over the next few days, it gets much better. You can see the typical bruise that happens on this side. It's a very, very small little dyspunctate, purple spots that fade nicely. What I'm going to have you do is I'm going to have her sit up and kind of evaluate it and then retouch it. Now it's all icing them. Nerve that comes out and is sensitive, but the rest of it is very numb. Almost done. And the nice thing about the injections.
To this area is that it lasts.
Almost a year, sometimes even longer. As opposed to the lips, for example, that lasts about four to six months. Okay, I'm going to have you sit up again for a second. That's it. No big bruise. We didn't really have any large bleeders that got in the way. I just like to massage this area, make sure it's perfectly smooth. And again, I don't feel any lumps or bumps. Any surface irregularities that we see is just swelling from around the injections. Kind of micro bruises, but there's absolutely nothing that's palpable as a lump. So in the next few days, as it settles down and she covers it with makeup, it's going to look a lot better. You can actually see how the area's contoured, has filled up just from looking from show how this area is kind of filled up nicely. This area here and this area here, that's it.
