Tear trough hollowness, a tough problem.

The tear trough is a very tricky area.  The skin is quite thin and almost anything you do other than hyaluronic acid fillers has a good chance of producing lumpiness.

For around the eye area, we prefer Prevelle, a hyaluronic acid filler that lasts about 3 months.  I have never seen swelling of any signifance from this filler.  Restylane is also fine for patients who aren't too sensitive.  Patients should always allow a little recovery time after Restylane.  Juvederm around the eyes tends to swell in some patients.

For the permanent fixes, we prefer a superficial cheeklift, limited or ultrashort incision (USIC) combined with conservative LiveFill (TM), an autologous nontraumatized graft.  We have found this to be more predictable than fat injection.  An additional advantage to LiveFill (TM) is that it is placed in one specific anatomic location, so if for some reason you didn't like it, it would be readily accessible.  We caution patients that not all the hollowness will be gone.  Rather, it is likely to be reduced.  They might need small amounts of filler if they require even more smoothness.

Semipermanent fillers or fat injection typically extravasate, or travel into several areas, making modification very difficult and sometimes technically impossible.

Any surgery around the eye should be very carefully and conservatively performed.  It is a shame to be the recipient of a permanent, undesireable result. 

Patients should be very cautious and seek surgeons with considerable experience in the lower eyelid and midface. They should also be cautious of doctors promising perfection, since even the bery best doctors in the world get irregularities from time to time.  They just don't get it often. 

Remember, this is your face, after all.

Dear Flagirl

My father always told me "if the butcher tells you the meat's bad, you should listen."

Too often when a doctor says that something can't be done, it means they have not figured out how to do it themselves. It does not necessarily mean that it can't be done. Before you give up on the best treatment option for the lower eyelid hollows, I suggest that you get some other opinions. In particular, you might look specifically for a cosmetic dermatologist who does the lower eyelid treatment because they are less likely to pressure you to do surgery.

Will surgery be right for you? Well for many, filling with Restylane is the best option. How about laser resurfacing? Generally, this can be a perfectly awful choice with the creation of a demarcation line and permanent textural changes in the the skin. Fat transfer is also less than idea in the tear trough hollow.   

Again, your best bet is to do your homework and find someone in your area who makes a lot of sense.

Helpful?

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