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Autologous exosomes – “extra rich” plasma
AUTHOR:
Dr Marta Chamerska
ophthalmologist, aesthetic medicine doctor
The eye area is considered one of the most challenging regions in aesthetic medicine, and there are still relatively few procedures that can be performed safely in this area.
Marta Chamerska, MD, ophthalmologist, aesthetic medicine doctor, and co-owner of Chamerscy Med in Olsztyn, discusses her preferred methods—from aesthetic treatments to blepharoplasty—as well as their indications and potential risks.
The skin around the eyes ages quickly due to its anatomical structure, rich facial expressions, and constant exposure to external factors. As a result, even relatively young patients seek treatment for issues such as dark circles, under-eye bags, and fine wrinkles.
Due to its anatomy, this area also carries a higher risk of complications compared to other parts of the face.
What complications are we most concerned about?
The most serious risk is vision loss caused by occlusion of the central retinal artery. The ophthalmic artery connects with terminal branches and the dorsal nasal artery, forming vascular anastomoses. In the event of embolization and material migration, this creates a risk of severe and often irreversible blindness.
This is therefore a high-risk area requiring in-depth anatomical knowledge, appropriate product selection, and precise injection techniques.
Even botulinum toxin—used safely in this area for decades—can cause complications such as eyelid ptosis, asymmetry, diplopia, or even herpes zoster reactivation (cases reported after forehead injections).
Complications may occur even in the most experienced hands, which is why the ability to manage them effectively is just as important.
A demanding recovery
Another reason why the eye area is considered challenging relates to post-procedure appearance. Bruising and swelling are common after injections (and even more so after blepharoplasty).
If the product is improperly selected or injected too superficially, it may become visible through the thin skin, causing the Tyndall effect. These symptoms are difficult to conceal—even with makeup—and since eye contact is central to human interaction, patients must be prepared for downtime.
Choosing the right treatment
Although I specialize in eyelid surgery, I always prefer less invasive aesthetic treatments when possible. Surgery is more often necessary for upper eyelid ptosis, where alternatives are limited.
For the lower eyelid, however, surgery should be considered a last resort. Aging in this area involves not only skin laxity but also ligament weakening and fat pad descent, leading to volume loss and deep folds.
If patients maintain tissue support through treatments such as hyaluronic acid mesotherapy, biostimulators, PRP, fibrin, or radiofrequency, aging can be slowed.
However, in cases of fat herniation or significant excess skin, blepharoplasty becomes necessary.
Tear trough
This is one of the most common concerns among patients aged 45–50. Treatment selection depends on individual indications, but I usually start with mesotherapy.
PRP works well by improving skin density and brightening dark circles, while fibrin is more effective in cases of greater volume loss.
Then I move on to biostimulators. One of my favorites is Juvelook—a hybrid collagen stimulator combining poly-D,L-lactic acid (PDLLA) and hyaluronic acid.
In one case, it allowed us to postpone blepharoplasty despite visible fat herniation. The skin became denser, ligaments strengthened, and the aesthetic result was satisfactory.
Safety of procedures
In the eye area, less is more, and the further from the lash line, the better—these are key principles I follow.
Excessive product leads to swelling and overcorrection. For Juvelook, I use a cannula, inject at the correct depth, in proper dilution, and never exceed 0.5 ml per side.
Treatments should be spaced at least two months apart to avoid overstimulation and allow proper tissue recovery.
Post-treatment swelling
Patients should plan procedures without time pressure—not before important events. Swelling and bruising are common.
In my experience, about 25% of patients develop swelling after Juvelook injections, especially those who previously had hyaluronic acid in the area.
Some practitioners recommend dissolving residual HA before using PDLLA to reduce this risk.
Post-procedure care is essential: rest, no alcohol, no intense activity, and proper hygiene (including changing pillowcases). The body needs time to regenerate, and results improve with proper recovery.
Post-blepharoplasty care
Recovery after upper eyelid surgery usually takes 3–4 days, and up to a week for lower eyelids. Patients should avoid strenuous activities such as travel or hiking during this period.
Scars on the upper eyelid may remain visible for several months but can be covered with makeup. Lower eyelid surgery involves more bruising but results in less visible scarring.
Scar stimulation after blepharoplasty
Treatments such as biostimulators, radiofrequency, PRP, and exosomes can accelerate healing and are typically introduced around 6 weeks post-surgery.
In some cases, slight undercorrection is necessary to prevent complications such as eyelid malposition. Additional stimulation helps achieve optimal results.
I have recently tested Centella asiatica-derived exosomes (Exovair), which significantly improve scar healing and fading.
I also frequently use radiofrequency, particularly RF Combo Jector, which allows multiple treatment modalities, including microneedling RF and PRP delivery. It is also the only device enabling simultaneous RF and injectable treatments such as Juvelook (excluding the eye area).
