Botox® and Fillers

Auckland Eye Botox and Fillers Page

Age changes in the eyelids.

With aging, the skin loses its natural elasticity. This, combined with the effects of gravity, tends to cause 'drooping' of the eyebrows and the appearance of redundant skin in the upper and lower eyelids. Muscles around the eye may also become thickened (hypertrophic), particularly?in smokers.

In addition, many people lose fat around the eye (atrophy), resulting in a sunken appearance. The connective tissue layers in the eyelids may thin out, causing fat to move downwards and form 'bags' under the eyes. Loss of elasticity and subcutaneous fat often leads to an increase in wrinkle formation (rhytid) and permanent lines such as frown lines.


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The results of these changes produce the cosmetic concerns many have regarding the eyelid region, the most common of which include:

  • overhang of upper lid skin
  • puffy looking eyelids
  • the appearance of 'bags' in the lower lids
  • hollowing associated with the 'tear trough'

Most of these concerns can be addressed by surgical or non-surgical means.

Botox® and fillers

Recently there has been increased awareness of the benefits of less invasive, non-surgical treatments such as Botox® and dermal fillers for some cosmetic eyelid conditions. Many patients prefer these non-surgical options as ones face changes over time and treatments can be tailored to match these changes.

Botox® (botulinum toxin) is a natural purified protein and has been used successfully in many millions of cases with a very high safety profile. Botox® has been used in the eyelids for functional problems over the past 25 years and more recently for cosmetic reasons.

Fat prolapse in lower eyelids

Fat prolapse in lower eyelids

Following Restylane® injection

Following Restylane® injection (volume replacement) below fat pads

Final result following further injections above fat pads

Final result following further injections above fat pads

Dermal fillers such as Restylane® are made from a substance which occurs naturally in the body's joint spaces called Hyaluronic Acid. It is gradually resorbed after injection but can often last for nine to eighteen months.

Fillers are in many cases the treatment of choice for lower lid fat prolapse particularly in the presence of a prominent 'tear trough'.

This case below demonstrates this as the lids were treated non-surgically with dermal fillers only.

Lines and wrinkles around the eye are most effectively treated with non-surgical procedures. Botox® is best used in the treatment of dynamic lines (those lines produced with facial expression). Used properly, it softens the lines and helps maintain a natural appearance with facial movement. Static lines are present permanently (although they can worsen with use of the facial muscles) and are largely unaffected by Botox® injections. If these lines are deep, the injection of tissue fillers can give a nice improvement.

Lateral eyelid line - 'crows feet'

Lateral eyelid line - 'crows feet'

Lines following injection of Botox®

Lines following injection of Botox®

The issues involved in cosmetic eyelid procedures are complex and this is a very specialised area to deal with, particularly when surgery can affect the comfort or function of the eye. Treatments may be surgical or non-surgical and the variations in anatomy of different genders and races need consideration, as do the changes naturally occurring with aging. The variety of treatments now available means most areas of concern can be appropriately managed with a high degree of patient satisfaction.

Auckland Eye - New Zealand Centre of Excellence for Eye Care