LIVE Under Eye Filler Procedure with Dr. Sonia Batra

– Hi everyone, welcome to Instagram Live. I’m Doctor Sonia Batra
from The Doctors TV show, and thank you for joining us. I’m here with Joseph today and, live in front of you, we’re going to be addressing
some of the dark hollows he has under his eyes, or dark circles, which just as you can see,
he’s handsome and he’s young, but he has had this for years. This has been more of a
genetic issue for you, correct? – Yeah it’s always been a genetic issue, my mom’s had it,
grandparent’s have had it, it’s always just run
straight in the family on my mom’s side. It’s like, doesn’t matter
how much sleep I get, doesn’t matter of any
of that stuff which is, always weird to me too
because I always thought it was sleep as opposed to anything else. – Mhmm, and it’s true when you sleep that your skin is restored so if
you’re not sleeping well, you’re going to look more tired, you’re going to get more
collection of that duskiness and that vascular pooling
which make you look like you have dark circles, but I agree with you, for you it’s not how
much sleep you’re getting or how tired you are, it’s really more structural, because you can see here, that he has this trough that’s
pretty, little bit shadowed and a little bit below
the level of the fat pad under his eye and the cheek, and that demarcation of
that trough is what people just on their own, sort
of interpret as a bag, and then it extends out here, this little bit of flattening
even up on the cheek, and then a slight bit of flattening even into the top of the cheek. So when we, one of the ways we address this when we treat this, is we often will think
about just propping this up. So what I’d like to do
today is actually put Hyaluronic acid gel, which is a filler, to kind of smooth this
demarcation and prop this up. So we’re gonna work in
this triangle here just to make you look a lot more rested. Now the goal is we never
want to over-do this, because we don’t want you to look puffy, or like you have
allergies, or over-plumped, but we just wanna bring that
deep trough up to a little bit more shallow area so it
doesn’t catch the light in the same way, it’s not a shadow, and it’s not interpreted
by people as a bag, you look more rested. So what we’re using is Hyaluronic acid. It’s a sugar gel filler
that’s naturally found in the joints, but it’s
obviously from a pharmaceutical company, and in a syringe, and it lasts about a
year in this location. So I know we already put a
little numbing cream on you just so that it doesn’t
feel too uncomfortable to do the procedure. The filler itself has a
little bit of anesthetic in it as well, which takes the edge off. But the interesting thing to note about it is it is going to attract water. So Hyaluronic acid is
moleculous like a sponge, and it attracts many times
it’s weight in water, and so initially you’re gonna look great right when we do this so
we’ll show an immediate before-after of what we’re doing, but you should expect to swell
for about two to three days. And ways to minimize that or
to avoid things in your blood and make you more prone
to bruising and swelling, so medications such as
Ibuprofen, Naproxen, even things like fish oil and Vitamin C that make you more prone
to bleeding and bruising, really bad idea, certainly
prior to this procedure as we discussed, but even
for 48 hours afterwards. We usually tell our patients
to avoid heavy exercise, saunas, steam rooms, things
that open up the vessels and make you more prone
to bruising and swelling. So I have my assistant Rachel with me, she’s gonna come over here too. She’s gonna help me
with a vein finder light – [Woman Behind Camera] Oh fun! Okay – Which I like to use
because it helps with an infrared, very safe wavelength, show us where the veins actually lie under the surface of the skin. So this, we like to use
anytime we’re going in an area that anatomically, is a
little bit challenging and under the eyes especially, there are a lot of critical
structures and blood vessels that we definitely don’t
wanna hit with the needle, so we like to use that as a tool. So, you ready? Do you
have any questions for me? – No, this is, I wanna see what
that does, it’s pretty cool. – Let’s get started! So we’re
gonna start on this side. And, I’m gonna have you turn
a little bit towards me, and bring your chin
down just a little bit, and Rach I’m gonna let
you bring the light up for me for just a minute. And so in real time what
you can see is the shadows are areas where he has blood vessels. So when we place the needle, we’re always trying to go
in the pink or the red area, to avoid those blood vessels. And then the placement for this filler is really kinda right down on bone. And what I’m trying to do
is just prop things up, the injection amounts are very small, and we’re just kinda going right in here, I’m gonna mold it a little bit. And you can even see
from the first injection that it’s come up a little bit, and we’re just gonna follow that trough, all the way through. How is that in terms of discomfort? Is that pretty tolerable? Is it feeling okay so far? – Yeah, it feels like,
it kinda feels like, you kinda get a little pinch. – [Doctor Batra] Like a little pinch right when the needle goes in? – Yeah, nothing crazy. – [Doctor Batra] That’s not too bad. And the nice thing about
this is I’ll show you in a hand-held mirror
right when we finish. It’s kinda instant gratification
because it props up the skin in real time as we’re injecting. Should look a little closer in. [Woman Behind Camera] So,
I have a question about, what actually are the dark circles? Like I know that they’re hereditary, but is it just thin skin? Is it nothing underneath the skin? – [Doctor Batra] So there’re
two reasons people get dark circles: People
like me who are of Asian or Middle-Eastern origin
often will have pigment deposition there, so it is
truly darker under the eyes. And so that’s one more genetic
reason for dark circles. The reason I think that Joseph does, as I’m propping this up, you’ll see there’s
actually no pigment here. The skin is the same colour
as the surrounding skin, it was really more shadowing
because of the depth. Now the other thing to
know is, we’ll go up here, is that the skin under the eyes is really thin and really vascular, so sometimes you can even
see the blood vessels there, and when the blood pools in those vessels, it can also give you kinda
a blue-ish tint or hue. And that’s what we often see
when someone hasn’t slept well, because they get that vascular pooling, or when someone has really bad allergies and it looks like they have dark circles, part of that is from rubbing your eyes which will increase
the pigment deposition, those are called allergic shiners. But part of that is also
just the vascular pooling due to allergies, and
that also makes people look more tired and like they
have bags under their eyes. So the genetic component for
Joseph is more from the volume because his structure, like
his mom’s like he said, it’s not as propped up, so it looks kind of hollowed out. In many people who are more
olive-toned or pigmented, the dark circles is true pigment, and that’s a genetic
predisposition as well. ‘Cause you said it was your mom right? Who gets these? – Yeah. – Okay, perfect, and relax completely. We’re gonna do one more little shot here. And then, so we like
to do a couple things. We like to use the AccuVein Finder just to kinda minimize the likelihood that I’m gonna hit a blood vessel, but we’re also in a room that
has a blood vessel laser, so if it turns out by accident, even despite using the vein finder, we hit a little blood vessel, we have the ability to
use the Pulsed Dye laser which will clamp it down, and also reduce the
likelihood that he would get a true shiner, or black and
blue marks from this treatment because as you can
imagine around the eyes, there’s just a lot of blood vessels, that’s why people get black eyes so easily from an injury or from trauma, so it’s nice to have a couple
of safe guards against that. And like I mentioned, it
helps a lot if someone hasn’t taken a bunch of
blood-thinning medicines before we do this
procedure for about a week, because then they don’t
bruise and swell as much. So that eye looks pretty good to me, and you can even see kinda one
side compared to the other, just I wanna show you for a
moment in a hand-held mirror, so you can see.. – It’s good. – [Doctor Batra] Yeah, so it’s instant! Right, it’s super fun! – [Woman Behind Camera]
Yeah, it really looks nice. – [Doctor Batra] That you can see, we didn’t try to alter him, we certainly didn’t try
to make him look puffy, but what we addressed here, and I can actually show you this, is, we tried to just prop up
the depth of this crease here, so it’s not, if you compare
this side we haven’t treated yet, but we will in just a moment, you can see there’s a deeper trough there. It looks a little more
shallowed and it looks a little more dusky because
the skin isn’t as propped up, you’re seeing some of
the blood vessels there. He’s a little red from
the actual injections but what I think you can see right away, is there’s not as much demarcation, it’s just smooth there
and a little more blended, and the nice end result about
is when people look at you, they’re not gonna know what you did.. (laughs) It’s not a really obvious like “Oh! He definitely put
filler under his eyes!” unless they watch this
video, they’ll know! (Joseph laughs) They’re just gonna think
that you look more rested, and you look like you got
the best night’s sleep of your life, or that
you’ve been on vacation. So that’s one of my favorite
aspects of feedback, that people will come back
and tell me after they’ve had this and it’s settled, they really will get all
these comments from people about how great they look, people say hey, did you change your hair? What did you do? But they can’t quite put
their finger on why someone looks better, and that’s
kind of always the end goal, is that it doesn’t look obvious, it’s a very subtle and very gratifying (mumbles) So now we’re start on the other side just so that we can bring
this side up to match. – [Woman Behind Camera]
You can really see it, the side by side. – [Doctor Batra] And it’s
nice to see the side-by-side because it is a subtle result, so it’s the kind of thing that once we do both sides and they match, people often forget and
they don’t know what we did, so it’s nice to see it in real time. Once things are symmetric, it’s harder to see the
difference from before. – [Woman Behind Camera]
Now, can doctors put too much filler under
your eye, for this reason? I mean there are like, when
they’re going to get this done. – [Doctor Batra] Yeah, absolutely! So when you’re going to get this done, the goal is always to be conservative, and less is more, because you don’t want
it to become what we call “convex” or raised above
the surrounding skin, because what happens then
is you just look like you’re having an allergic reaction, you don’t look rested at all! You just look puffy and
swollen, like you’ve been crying or having really bad allergies, and sadly I think everybody
has seen a bad example of that, where someone looks really
puffed up and sort of bloated. With this treatment, less is always more. And the other critical thing with this, is remember, this looks pretty easy, it looks like I’m just
jabbing him with needles, but you have to know the
anatomy in this area. This is a really tricky area with a lot of blood vessels and nerves, and you should never, ever
have someone who’s not trained and fully qualified
to do this type of procedure, do something like this near your eye. Because injecting into the blood vessel can threaten your vision. It’s a really, really dangerous outcome. So you want someone who really understands and knows the anatomy of this area, who knows where they blood
vessels lie, for sure, and who’s experienced with this, that you’re not the first person that they’re sticking a needle into! It’s, you have to be very careful, and that’s true with
any cosmetic procedure, because as we’re doing
so many more of them, they’re accessible and
people see them on Instagram, and they think “Oh yeah,
looks really easy!” There’s a lot of training
and experience that goes into any procedure, you want to make sure the
practitioner has actually had that before they’re
doing anything on you. So, short answer is yes. You can do too much, it can look very unnatural, and the nice thing about
this filler in particular, Hyaluronic acid, is it can be dissolved. So there is an enzyme
called Hyaluronidase, so if you’re ever in a bad situation where you’ve had a Hyaluronic acid filler and it just doesn’t look good and it looks too puffy or unnatural, rest assured there is a
product that you can use to bring it down and to dissolve it. So at least there’s that safe guard with this particular class of (mumbles). Joseph, how are you feeling? – [Joseph] Good! Yeah! – [Doctor Batra] Yeah? What did you think of the one
side compared to the other? – I loved it, it was interesting
just to see the difference, but it was like you said,
it was subtle in a way of, “Oh I look more rested in that eye” and the other eye looks like “Oh, it looks like I didn’t get sleep”, it’s pretty cool. – [Doctor Batra] Yeah, it’s really, in real time, it’s nice
to see that comparison. – [Woman Behind Camera]
Do dark circles get darker as you get older? Or is it just because you
lose volume in your eye? Is it true? – That’s exactly right. So as we age, we sadly all
lose that sub-structure and that volume in the face, it’s one of the hardest
parts of aging, it really is, because you lose bone, you
lose muscle and you lose fat. And the skin itself becomes less elastic, it starts to sag, and so anywhere that you’re
already losing volume becomes accentuated with time, and then the (mumbles)
is that people like me who also have a tendency to lose pigment. As we age, we have more
discoloration and pigment as well and that’s why any of my
patients watching this, know I’m a complete fanatic, if not a Nazi about sunscreen, and how
important it is to always wear your good zinc-based
sunscreen rain or shine, to prevent that discoloration
which is so aging. – [Woman Behind Camera]
I learned that from you, a mineral-based sunscreen is the best! Zinc-based. – [Doctor Batra] I’m gonna
mold this a little bit, and then I’m gonna show you in the mirror. But, one thing I always
like to point out to people, is that I’ve purposefully have
left you with some trough. We can’t overly obliterate
it and get rid of it, or you will look really unnatural. But what we did try to
do is just bring it up and make it even, so that you look more rested. Now the good news is,
you’re not bruising at all, you can take a look in the mirror and see. – So funny to me! – [Woman Behind Camera]
Yeah it’s really nice! And so you said it
would last about a year? – It should last about a year, and the reason for that is, it’s in an area where he’s
not going to be moving, it’s right above the bone. Generally when we put filler in areas which are really mobile, like the lips for example, you metabolize it a
little bit more quickly, but somewhere like this
where it’s gonna stay right where we put it, and we placed it fairly deeply, it usually lasts about a year. And then gradually, that
enzyme I was mentioning, Hyaluronidase, we already
have that in our systems, because it’s what breaks down the Hyaluronic acid in our joints, that goes in and it’ll
metabolize and break down any outside force of
Hyaluronic acid as well. Any more questions? – What’s the best way if, I already have the dark
circle aspect there, I think anybody who has dark circles, what’s the best way to
end up lightening those, is there any type of creams
or anything anybody can use that can help with that? – Yeah, absolutely. So if the dark circles
are more due to shadowing, and especially many of us have
creneation of the fat pads behind the eyes, and
that’s what gives you that really puffy bag, then I always tell people, yeah use an over-the-counter product with caffeine in it, because you taste it instead of (mumbles), so that you don’t have
quite the (mumbles) bag. There are many products on
the market that actually form a very interesting foam on your skin that temporarily will tighten the skin. (mumbles) That’s for more of like a quick fix. In the long-term, we fear
more prone to discoloration under the eye from pigment, you can get a good, very
safe lightening cream, (mumbles), you can get Vitamin C,
you can get a (mumbles), even retinoids which are
good cell turnover agents are all great ways to
address the pigment and what’s causing this
discoloration in your eye. – [Woman Behind Camera]
Okay great! Alright. – Well, thank you for joining
us for the Instagram Live, thank you Joseph for
sharing your experience, thank you Rachel for the assist. And thanks for joining us! – [Woman Behind Camera] Thanks, bye!


  1. This is so cool makes me want to study medicine just to for this. Can one perform cosmetic procedures as a nurse??

  2. Dr Batra is awesome — she explains things in a way that’s very thorough and comprehensive, almost academic, but she never sounds condescending.

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