PRP For Under Eye Treatment

Read and learn about PRP injection to the under eye to improve overall appearance and to fight aging! Please also enjoy a video we made of the treatment experience in our office. In this edition we will cover:

• Platelet-Rich Plasma (PRP) - what it is and how we extract it from your own body
• Step-by-step description of the treatment
• Treatment plan - how frequently it is needed
• Risks and recovery

PRP injection to the under eye is fantastic for patients age 30 and older. This treatment can help improve signs of aging that already exist, and can also help prevent signs of aging by building your collagen that is lost naturally with age. 

PRP and The Lower Eyelid

This is my first blog about any sort of injectable and I wanted to begin with a topic that my patients bring up all the time. What options exist to treat dark, tired-appearing lower eyelids? My favored approach to treat this problem is a Platelet-Rich Plasma injection. The lower eyelid has complex anatomy with fine structures that quickly show aging, dehydration, allergies, inflammation, and sun damage. Dark and tired appearing lower lids have many contributing factors but in sum are largely due to very thin skin (some of the thinnest skin found on the human body), visible muscle and veins beneath the skin, and volume fluctuations from age or hydration. 

My patients know that when it comes to the lower lid I do not mess around. I don’t take risks, and I don’t liberally inject filler. There are good indications for carefully placed filler but I exercise great caution because the anatomy of this region cannot take a joke. I believe that graceful aging is better than poorly indicated procedures that give unnatural appearing outcomes. If you are my patient, I have probably talked you OUT of under-eye filler at some point and offered you a PRP treatment instead. So what exactly is PRP? 

Platelet-Rich Plasma (PRP) injections utilizes your own blood and the specialized cells that naturally exist in your plasma to direct tissue regeneration at the injection site. Why do we care about platelets? Why is “platelet-rich” important? Platelets are powerhouses that release growth factors that act as signals in the body to stimulate tissue regeneration including collagen formation. If you aren’t familiar with the key role of collagen in skin health and fighting the aging process, you can read the details in my newsletter #1. The principles of skin aging and the science behind proper skincare are the same principles that support PRP injections as a targeted procedure to rejuvenate the lower lids. The targeted problem is a delicate area of the face that has lost collagen + elastin with age, tissue support underneath the visible skin that recedes + falls with age, and a lymphatic system that is very sensitive to local inflammation. Maybe I am a nerd but I think the concept behind PRP is so cool. We are hacking our own body in order to route cells where we want them. 

When you come to my office for a PRP treatment this is what you can expect:

1. Blood Collection: I use a butterfly needle to stick the juiciest vein I can find in your arm and collect blood in a vial. This blood is composed of red blood cells, white blood cells, platelets, and plasma. 
2. Centrifugation: I take the vial of your blood and place it in a centrifuge which then spins at high speeds and separates the blood into it’s components based upon the density of cells. After 10 minutes in the centrifuge the plasma + growth factors are separate from the red and white blood cells. 
3. Plasma Concentration: I further process the plasma in order to ensure that the platelet-rich portion of the plasma is included in my prepared injection. 
4. Injection: I load the PRP into small syringes ready for injection. Depending on your evaluation and treatment plan I will either inject with a small needle (the same size I use for Botox/Dysport/Xeomin) or I use a blunt cannula. With either needle or cannula technique I practice safety measures while injecting to protect important nerves, your eyeball, and to prevent injection into a blood vessel. 

Treatment Plan and Touchups 

I recommend a series of three treatments separated by at least 4 weeks. After the series of three treatments I like to compare before and after pictures with my patient. We decide together if PRP injections are giving them a result that is a good return on their investment. If they are loving their results then I schedule them for maintenance injections 1-2 times yearly. 

Risks and Recovery 

1. Bruising and Swelling: the most common risk is bruising due to the vascular nature of the lower eyelid. Bruising is quite common even when I carefully avoid the visible vessels. Don’t plan this procedure the same week as an important social event of first date. Swelling varies but can peak at day 3 and should be nearly gone by day 4.
2. Infection: there is risk for infection with any injection procedure, in my hands this risk is quite because of the proper technique I use. 
3. Discomfort: there is always some pain associated with needle sticks and injections however this procedure is tolerated even without any numbing medication (which I do offer all patients). 
4. Allergic Reaction: theoretically this is possible however quite low because the injected material is your own blood.
5. No Improvement: there is always a risk that this treatment does not result in a visible change in your lower lids. I encourage 
6. Injury: important structures near the eyelid include the eye, nerves, and a network of blood vessels that feed the face + eye. The eye is easy to protect as I use my own finger as a barrier between my injecting hand and the eyeball. The biggest, most devastating risk is the possibility for intra-vascular injection. If the concentrated PRP solution is injected into a blood vessel there is a chance that the cells could cause a clot that stops blood flow either to the face or to the eye resulting in blindness. I am confident in the safety of this procedure in my hands because prior to each injection I pull back on the syringe to ensure that I am not in a vessel. I do warn all of my patients of this risk. 

I want to encourage my friends, family, and patients to never settle for anything less than an expert when it comes to injectables. One of the benefits of having a plastic surgeon as your injector is that there is no person more qualified to inject.  Nobody knows or appreciates the complex anatomy of the face like someone who has been surgically intimate with each layer. I have first-hand information imbedded in my visual cortex of where important structures lie, and I have a very healthy fear of injecting in danger zones. I have a very real understanding of where the deep structures live within the face because I have dissected through every layer of the eyelid to perform reconstruction of the orbit from the bones to skin. It is so important to be able to trust your safety and your aesthetic outcome in the hands of your injector. I want the best for my patients and for me this means safety first, then aesthetically pleasing and achievable goals.

Here’s to aging, on our own terms!

Dr. Lindsey Tavakolian, MD