1. Initial Consultation: The process begins with a thorough consultation with Dr Arun, who will assess your facial structure, skin condition, and discuss your aesthetic goals.

2. Medical Assessment: Your medical history will be reviewed to ensure you're a suitable candidate. Dr Arun will check for allergies, previous reactions to fillers, and any contraindications.

3. Treatment Planning: Based on your facial anatomy and desired results, Dr Arun will develop a tailored treatment plan

1. Cleansing: Dr Arun thoroughly cleanses the treatment area to remove any makeup, oils, or impurities.

2. Topical Anaesthetic Application: A numbing cream is applied to minimise discomfort during the procedure. This typically requires 5 minutes to take effect.

3. Treatment Mapping: Dr Arun then marks the areas to be injected, carefully planning placement for optimal results.

4. Filler Injection: Using a fine needle or cannula, the dermal filler (hyaluronic acid-based) is precisely injected into predetermined areas of the lips.

5. Massage and Molding: Dr Arun gently massages the product to ensure even distribution and proper contouring.

6. Final Assessment: Both Dr Arun and the patient evaluate the immediate results, with potential touch-ups applied as needed.

7. Post-Treatment Care Instructions: Dr Arun provides detailed aftercare guidelines to optimise healing and results.

Aftercare notes for tear-trough filler treatment:

Needle entry points, redness, bruising, swelling and asymmetry around injection sites immediately after treatment is normal due to the very nature of the treatment.

There may also be some tenderness present as the bruising and inflammation sets in. These symptoms will resolve over the next 2-7 days, depending on your individual response to the treatment. It may take a full 2-4 weeks for all swelling to settle; until this time we cannot re-treat.

For 24 hours avoid:

• Touching your face

• Applying makeup

• Skincare with active ingredients

For 48 hours avoid:

• Intense physical activity

• Sleeping on side or front

• Spa's/Saunas

• Massage/facials

• Touching/rubbing/massaging/exfoliating/applying pressure to treated areas

• Alcohol & blood thinning medications

For 7 days avoid:

• Avoid rubbing your eyes

This treatment typically lasts for approximately 12–24 months before requiring a top-up. The longevity of results varies based on several factors.

• Genetics: Some people are naturally predisposed to darker under-eye skin due to hereditary factors.

• Sun exposure: UV radiation can stimulate melanin production, leading to increased pigmentation.

• Ageing: As skin becomes thinner with age, blood vessels become more visible, contributing to a darker appearance.

• Lack of sleep: Poor sleep can cause the skin to appear paler, making dark circles more prominent.

• Allergies: Histamine release can dilate blood vessels and cause inflammation, darkening the under-eye area.

• Dehydration: Insufficient hydration can make the skin appear dull and accentuate dark circles.

• Medical conditions: Anaemia, thyroid problems, or vitamin deficiencies can contribute to hyperpigmentation.

• Vitamin C serum: A potent antioxidant that brightens the under-eye area, reduces melanin production, and protects against free radical damage from UV exposure and environmental stressors.

• Sunekos: An injectable treatment containing hyaluronic acid and amino acids that stimulates collagen and elastin production, improving skin texture and reducing pigmentation in the under-eye area.

• Hydroquinone: A topical skin-lightening agent that inhibits melanin production, often considered the gold standard for treating hyperpigmentation (should be used under medical supervision).

• Retinol: A vitamin A derivative that accelerates cell turnover, fades dark spots, and improves skin texture, though it should be used cautiously around the delicate eye area.

• Tretinoin: A prescription-strength retinoid that's more potent than retinol, effectively treating hyperpigmentation by increasing cell turnover and inhibiting melanin production.

• Pico laser: An advanced laser technology that delivers ultra-short picosecond pulses to shatter pigment particles more effectively than traditional lasers, treating under-eye hyperpigmentation with minimal heat damage to surrounding tissue and reduced downtime.

• Ageing: As we age, the skin naturally loses collagen and elastin, proteins that keep skin firm and elastic. This loss is particularly noticeable in the thin under-eye area.

• Sun damage: UV exposure breaks down collagen and accelerates skin ageing, leading to premature wrinkling and crepey texture.

• Dehydration: Lack of moisture causes the skin to appear dry, thin, and more prone to fine lines and crepiness.

• Genetics: Some people are predisposed to thinner skin or earlier collagen loss due to hereditary factors.

• Lifestyle factors: Smoking, poor diet, lack of sleep, and excessive alcohol consumption can all contribute to skin deterioration.

• Volume loss: Loss of fat beneath the skin can make the area appear hollow and emphasise the crepey texture.

• Moisturise regularly: Use hydrating eye creams containing hyaluronic acid or ceramides to plump and smooth the skin.

• Sun protection: Wear sunglasses and apply SPF 30+ around the eyes daily to prevent further UV damage.

• Stay hydrated: Drink plenty of water and maintain overall skin hydration.

• Healthy lifestyle: Get adequate sleep, eat a balanced diet rich in antioxidants, and avoid smoking.

• Sunekos treatments: Sunekos injections contain hyaluronic acid and amino acids that stimulate collagen and elastin production. They can be used on both the lower and upper eyelids to improve skin quality, reduce crepiness, and restore a smoother, more youthful appearance to the delicate eye area.

• Tretinoin and retinol: Prescription tretinoin (a stronger form of vitamin A) and over-the-counter retinol are highly effective for treating under-eye crepiness. They work by increasing cell turnover, boosting collagen production, and improving skin thickness and texture. Start with a low concentration and gradually increase usage to minimise irritation in this sensitive area.

• CO2 laser resurfacing: Fractional CO2 laser treatment is a highly effective option for under-eye crepiness. It works by creating microscopic columns of thermal damage in the skin, which stimulates collagen remodelling and skin tightening. The treatment can significantly improve skin texture, reduce fine lines, and diminish crepey appearance. Recovery typically takes 5-7 days, with redness and mild swelling. Results continue to improve over several months as new collagen forms. It's important to seek an experienced practitioner, as the under-eye area requires careful, conservative treatment settings.

Endolift is a minimally invasive laser treatment that uses an internal laser fibre to target and treat malar bags from beneath the skin.

How Endolift Works

1. Laser fibre insertion: A thin optical fibre (approximately 300 microns) is inserted through a tiny incision under local anaesthesia

2. Internal heating: The laser delivers controlled thermal energy directly to the deeper layers of skin and subcutaneous tissue

3. Tissue tightening: The heat stimulates collagen production and causes immediate tissue contraction

4. Fat reduction: The laser can also target excess fat deposits contributing to the bags

5. Skin tightening: The thermal effect tightens loose skin and improves elasticity

Benefits of Endolift for Malar Bags

• Minimally invasive: No large incisions or extensive surgery required

• Local anaesthesia: Performed under local anaesthetic rather than general anaesthesia

• Minimal downtime: Most patients return to normal activities within a few days

• Immediate tightening: Some results visible immediately, with continued improvement over several months

• Collagen stimulation: Promotes long-term skin rejuvenation through natural collagen production

• Reduced swelling: Targets the underlying causes of puffiness and fluid retention

• Natural-looking results: Gradual improvement creates subtle, natural-looking outcomes

Treatment Process

Consultation: Assessment of malar bags and suitability for Endolift treatment

Preparation: The treatment area is cleaned and local anaesthetic is applied

Treatment: The laser fibre is inserted and moved systematically through the treatment area (typically 30-60 minutes)

Recovery: Mild swelling and bruising may occur for several days

Results: Initial tightening visible immediately, with optimal results appearing over 3-6 months as collagen remodelling occurs

Expected Outcomes

• Reduction in puffiness and swelling of malar bags

• Improved skin texture and firmness in the cheek area

• More defined cheekbone contour

• Rejuvenated, less tired appearance

• Results typically lasting 2-3 years or longer

Considerations

Not suitable for everyone: Severe cases may require alternative treatments or surgical intervention

Multiple sessions: Some patients may benefit from additional treatments for optimal results

Combination treatments: May be combined with other aesthetic procedures for comprehensive facial rejuvenation

Side effects: Temporary swelling, bruising, and mild discomfort are common but typically resolve within a week

We offer Endolift treatments for malar bags in London, Mayfair, 15 Dover Street, W1S 4LP. For more information and suitability please book a consultation.

• Treatment Area: Fillers in highly mobile areas such as lips tend to break down faster than less mobile areas

• Metabolism: People with faster metabolisms may break down fillers more quickly

• Lifestyle: Sun exposure, smoking, saunas and intense physical activity can reduce longevity

• Injection Technique: The skill of the injector can impact how long results last

• Type of Filler: dense fillers tend to last longer than soft fillers.

1. Hollowness under the eyes

2. A sunken appearance to the eye

3. Dark circles under the eye
   
   Under-eye fillers won't address pigmentation issues. If pigmentation is a concern, it will be identified during your consultation. We can then recommend specific skin creams, including prescribed Obagi products, which will be delivered to you. Alternatively, if you're a suitable candidate for Sunekos, we can discuss its benefits in more detail during the consultation.
   
   In addition, people with severe under eye bags may not respond well to this treatment, in which case we can advise you accordingly on how to treat this issue. Book a consultation.

This treatment can be performed alongside many of our other treatments. It may sometimes be more convenient to do so if you've been recommended another treatment to complement your features. Sometimes we combine tear trough filler with cheek filler to build up support beneath this area. We can also combine the treatment with anti-wrinkle injections to the crow's feet and brow areas to reduce fine lines and gently lift the brow. The combination of these treatments can result in a dramatic improvement to the entire eye area. If you have both hollowing and hyperpigmentation, we would need to address the hollowing under the eyes first, before addressing skin quality and hyperpigmentation with Sunekos two weeks later, or with medical-grade skin products.

Yes, tear trough filler can help reduce under eye wrinkles. We also sometimes treat under eye wrinkles conservatively with anti-wrinkle injections and this can help dramatically for certain clients.

Yes, we use hyaluronic acid fillers to treat the under the eye, reversible at any time. Therefore they can be dissolved if a client does not like the result or if a complication arises (however, this is extremely rare).

When addressing tear troughs, we use Teoxane Teosyal Redensity 2. Recognised as one of the thinnest filler available on the market, it is particularly effective for this facial region due to the extreme delicacy of the skin beneath the eyes.