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Undereye hollows can be treated by a variety of techniques from injectable to implant materials. By far the injectable approach is the most common where temporary injectable fillers are frequently used. While these injectable approaches are rarely perfect that usually offer natural reversibility based on the composition of the material. This is why injectable fillers composed of hyaluronic acid-based materials are usually best as they offer the most assured dissolution should the aesthetic result be unsatisfactory.

While patients often understandably desire permanent injectable fillers, one must be very careful of this wish. Should a permanent filler the used, such as silicone oil, it can be very difficult or impossible to remove if so desired. Such removal can only be attempted, and attempted is the correct choice of words, through an open excisional approach. And unlike many other injectable fillers, where they can be founds in liquid pools or discrete collections in the tissues, such is not the case with most silicone oil injections.

In this recent case of an open lower eyelid approach for efforts at subtotal removal of silicone injections under the eyes, the injected tissues can be seen as a glistening irregular mass interspersed within the tissues. This would be expected as that is the basis of how liquid silicone works as an injected filler. …it causes a fibrous reaction of scar tissue that encapsulates the foreign material. It is the scar tissue reaction that causes more of the sustained augmentation effect than the actual injectate itself.

As a result wide excision of tissues are needed to remove the material which runs the risk of creating external contour irregularities. This would be of great relevance when trying to remove injected silicone from under the eyes where the skin and tissue layers are natural thinner and aesthetically more unforgiving.

Dr. Barry Eppley

Indianapolis, Indiana

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