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A Deep Dive on Dissolving Fillers: what is the enzyme and is it safe?

Dr Kotlus explains how hyaluronidase works to dissolve filler with an injection and he shows what the literature says about safety

Cannula tear trough filler under eyes for dark circles and eye bags

Cannula tear trough filler

Eye bags and dark circles may be present from birth or can develop with age.  They make us look older and more tired.

In my NYC practice I fill the so-called tear trough to minimize hollowing under the eyes and to soften the under-eye contour.  Filling this area makes the eyes look less tired.

Here is what a tear trough is: it’s a valley under the eyelid that contributes to shadows, dark circles, and the appearance of under-eye bags.  I describe it at more length here.  It is caused by the tight attachment between the eye closure sphincter muscle (orbicularis oculi) and the rim of bone under the eye.

The cannula tear trough filler treatment is a way to minimize or eliminate eye bags without surgery.

See this example:

filler under eye

Another example:

How is cannula tear trough filler done ?

An injection delicately and precisely places a biocompatible material under the skin to lift the sunken area.

There are a few filler types available (Restylane, Juvederm, Restylane Lyft, Belotero, Volbella, Vollure,  etc.), and these consist of gels that are packaged in a syringe or a tube.  At the tip of this tube is a needle or a cannula that delivers the gel in the right place.

Restylane is arguably the best filler for the under-eyes.

Read this article to hear more about why Restylane is the best for under eyes based on my experience with thousands of treatments over more than 12 years.

Needle vs. cannula

A needle is the traditional way of performing filler treatments.  It has a sharp tip and works with a high degree of accuracy.

A cannula is similar to a needle but the tip is not sharp, it is blunt and rounded.  The cannula eye lift has a few benefits:

1. Cannulas can be less likely to cause bruising after filler treatment

2. Cannulas may be less painful than needles

3. Cannulas may require less entry points because they tend to be longer than needles

4. Cannulas may be safer than needles because it is less likely to puncture a blood vessel and inject filler where it doesn’t belong

Which one do I use?

I use cannulas for the tear trough, mainly because of the improved safety and reduced risk of bruising.  Here in NYC, my patients want to be able to return to their busy lives with minimal recovery time.  The cannula makes that much more likely than needle treatments for eye bags.

However, I don’t use cannulas for every filler treatment I perform because certain situations are better suited for needle injections (e.g. shallow fine lines, acne scars, surgical scars).

Example of cannula eye lift with Restylane immediately after one side was completed:

eye bag cannula

How long does the cannula eye lift last?

After under-eye Restylane treatment, you should expect a year or more of improvement in the appearance of eye bags.  If the upper cheeks are filled at the same time, the results can last longer due to the improved volumetric support.

Surgery or filler for eye bags?

Aside from the cannula eye lift, there are both surgical and non-surgical ways to improve the under eyes- I created an infographic that helps you decide if fillers or surgery are a better option for you.  You can find it by clicking here.

Before and after cannula eye lift with Restylane

eye bags filler

eye cannula
 under eye filler

cannula eye lift

Getting the cannula eye lift in NY

When patients come in for the cannula eye lift, they often have their initial consultation and their treatment on the same day.  The entire procedure takes about 15 minutes.  I highly recommend you see a cosmetic eyelid surgery specialist (oculoplastic surgeon) for the procedure.  A good portion of my practice is devoted to correction of eye procedures performed elsewhere by non-eyelid specialists (revision procedures) and this includes correction of under-eye fillers that were incorrectly administered.  It’s best to get it right the first time but if you do encounter an issue a fix is usually possible.

Phone: 212-882-1011

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