For post lower eyelid blepharoplasty volume loss, Restylane and Lidocaine are safest administered via a single port incision and entry point, using a fine cannula. An incision is made with a needle after a bit of local anaesthetic has been injected. The entry point is first tunnelled with a needle of the correct size and then the cannula, which is very fine, is gently advanced through the opening into the deep tissues of the upper cheek and lower eyelid to cheek margin. Very delicately, the cannula can be felt as it goes along inside and helped by the surgeon it goes up towards the areas that need to be filled; namely the upper cheek, the area of triangular atrophy, sometimes the upper outer cheek, and of course into the tear trough area.
The patient feels very little. If they do give an involuntary mini reaction, I withdraw the cannula and go into a safer, more comfortable area in the cheek and lower eyelid. There is the infraorbital nerve below the eye, which comes out into the cheek below the eye, and I try and avoid that area because that can be quite tender, instead aiming to keep above the sensitive nerve at all times.
When using filler for the first time on a patient, I always recommend that the patient has a small amount consisting of one mL and then that they return to have a 2nd mL about three weeks later and a 3rd mL another three weeks after that. This is because we do not know exactly how much filler they are going to require and it may be that one mL is going to be perfectly adequate. It is also important to wait long enough after the cannula injection of filler for any associated mild bruising and swelling to have fully settled.
After I have assessed my patient, we never go straight to TearFill treatment on the same day. However, I will write a medical resumé based on the consultation and examination, where I give my recommendations, plus an estimate of prices. That way, my patient can make a decision as to whether they want to go ahead with tear trough filler where they have had the previous blepharoplasty, or not.
Having the previous blepharoplasty is not a contraindication to having filler. The only warning I give my patients is that there may be some areas where there is some internal scarring where I have to push a little bit harder. That can be minimally tender, or it is just not possible to push through, in which case I have to use a direct needle technique instead of a cannula for those areas.