Dr Kiran Hebbalkar, Cosmetologist and Dermatologist, Kiran’s Clinic, Mumbai, and Dr Shirreen Y Poonawala, Dermato-Cosmetologist, Trichologist and Laser Surgeon, Skin Vibbes, Pune, discuss the effectiveness of Restylane for bright eyes as part of the Let’s Talk Series by Aesthetic Medicine India in association with Galderma.

D rHebbalkar led the discussion by listing out the key concerns about the eye area. Eyes start ageing faster than other areas of the face and treating the periorbital area is very challenging because the skin is very thin and is more prone to fine lines or wrinkling. There’s less collagen, the elasticity is disturbed, and we tend to have sagging skin. The pigmentation around the skin of the eyes also matters a lot. Due to the vascularity, this area is difficult to treat. Eye bags due to weight loss and age, laxity of the ligaments, presence of lesions such as xanthelasma or skin tags are other concerns. To treat them and get bright eyes, from Galderma’s aesthetic collection, we have Restylane Classic, which is a neuromodulator HA filler.

The firm NASHA gel technology helps give an even contour and a soft look to certain areas of your face. Speaking about the eyes, the orbicularis retaining ligament causes the sagging around the periorbital region. Dr Hebbalkar said, “When we treat tear troughs and we are injecting the orbital link, we are supporting the orbital retaining ligament.

When we work on mid cheek points, we are targeting to treat the zygomatic cutaneous ligament so that it gives support for the mid cheek and the orbital rim. We get better results when we work around the ligaments, keeping vascularity in mind.”

CASE STUDY 1

Patient’s profile: A 35-year-old female complaining of hollowness around her eye. She had botulinum toxin in the past and her skin was a bit photo damaged. She was given a skin rejuvenation treatment. Sunscreen, topicals, filler and correction using botulinum toxin was advised. “A slimmer V-shaped face was achieved using Restylane Lyft and the refinement was done with Restylane OBT,” said Dr Poonawala.

Dr Hebbalkar’s opinion: We need to first target her mid-cheek so that we stabilise the ligaments. Then we approach the vital ring to reduce the volume correction in the periorbital region for better results.

CASE STUDY 2

Patient’s profile: A 45-year-old female with photo ageing, rounding of the face, prominent nasolabial folds and tear trough and melasma.

Dr Hebbalkar’s opinion: The pigmentation in this case is difficult because of the nasolabial line. Even if you correct it with fillers, it will still stand out. So, we need to work on her skin quality by using the combination of creams, moisturisers and sunscreens. My favourite treatment for a case would be Q switch laser combined with PRP. Then go for mid-cheek correction, followed by periorbital hydrating fillers. Add a combination of lasers to improve the strength of the skin.

CASE STUDY 3

Patient’s profile: A 30-year-old female with prominent under eye bags, tear trough and nasolabial fold, and skin damage due to screen time.

Dr Hebbalkar’s opinion: Her skin is dry and pigmented. Start with a skincare routine to give her more hydration. For patients not ready for fillers, we can do HIFU. I suggest HIFU for two sessions. Once collagen starts building, volume reduction is seen on the lower part of the face. Then you start working on the midcheek and then correct the tear trough.

Dr Poonawala’s opinion: We gave her Restylane Lyft, using the NASHA technology to support the zygomatic ligament. For the mid-cheek, we did fillers in the deep fat pads, followed by refinement with Restylane.

CASE STUDY 4

Patient’s profile: A female actor in her early 30s with sagging cheeks and concern around the periorbital area.

Dr Hebbalkar’s opinion: I started with Restylane for the periorbital concern and worked with cannula because I needed to reach to the medial part of the tear trough. In the first session, I used one ml only and then the second one we did after six months.

CASE STUDY 5

Patient’s profile: A girl in her late twenties with a shadowing effect under the eyes and volume loss. Dr Hebbalkar’s opinion: I counselled her on improving her eating habits. I worked on her tear trough with Restylane with the periorbital bolus technique. Within one session, it improved the periorbital region.

Dr Poonawala’s opinion: In a young patient, we can always work on lifestyle changes along with regular use of sunscreen.

CASE STUDY 6

Patient’s profile: Middle-aged male with photo damaged skin, especially around the eyes.

Dr Poonawala’s opinion: There is a lot of hollowness, tissue loss and bone resorption. We should begin with temporal strengthening, as that would improve the cheek sagging and nasolabial lines. He has zygomatic ligament support. Refinement will do the trick for him along with post-care and use of sunscreen and retinol.

Dr Hebbalkar’s opinion: As his skin was super sensitive, I started with a proper moisturiser and night repair cream. I worked on the lateral part of the cheek first, and then I came to the centre, around the eyes, where I used Restylane. I used different skinboosters to improve the quality of the skin. I gave him skinboosters six months apart, but still it made a lot of difference.