I have very deep tear troughs that are genetic. I recently went to a dermatologist that informed me that fillers would not help my situation. She said fillers are not meant for the tear trough. Should I see a second opinion? Should I see a plastic surgeon instead of a dermatologist?
Is It True That Fillers Are Not for Tear Troughs?
Doctor Answers (8)
Fillers can soften the tear trough
Fillers can be used to soften the tear trough area. The choice of filler is important> I prefer the hyaluronic aced fillers because of their consistency, clear nature, and reversibility. Especially in this area, the skin is very thin, lumps may occur and it is nice to be able to inject a hyaluronidase which can smooth the area in a day or two.
Autologous fat transfer is an excellent filler, however I prefer to perform this procedure in the operating room.
Filling the Tear Trough
Fillers can be an effective means of softening the tear trough. Knowledge of anatomy is critical here because superficial placement of the filler can create visible asymmetries as well as a Blueish tint to the skin.
Filler must be placed in the proper anatomic plane, preferably using an HA filler such as Juvederm.
Fillers are GOOD for tear troughs
In a patient with the right anatomy and good skin, fillers are among the best ways to improve the tear troughs. They work better and are more predictable than fat injections in my opinion.
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Tear Troughs Can Be Injected
It may be worth your while to seek a second opinion. The tear troughs can be injected with a dermal filler if the client is a good candidate for the procedure. The area above the orbital rim cannon be injected. It also would depend on which part of the tear trough has the hallowing.
Fillers can help tear troughs
Certain fillers can do wonders for making tear troughs less noticeable. My patients commonly tell me that even though they feel tired and sleep-deprived, their filler makes they look well rested! However, it's very important to go to someone experienced in treating this area. Certain people have very prominent fat pads under their eyes, and these patients are probably best suited for surgery. However, many patients who have hollows can absolutely benefit from a small amount of filler. I usually start with only a drop and then we can always add more. Too much filler in this area can look very artificial, so be sure to go to someone who is conservative and is looking to help you achieve a natural look
Fillers not the first choice for tear troughs
Facial fillers are not the best choice for tear troughs. This area has inherently thin skin and can easily show the fillers underneath the skin. They can have a lumpy or blueish appearance (tinseling). This is probably the area most prone to unsatisfactory results or complications and for this reason fillers are generally avoided or used with extreme caution. This is not a good solution for severe tear trough deformities. The best option is something called a mid face lift which repositions the fat in the area and gives a more permanent soft result.
When it comes to choosing between a plastic surgeon and a dermatologist it would depend on the problem. Problems with the skin cancer, hypo-pigmentation, crepe like appearance of the skin, fine wrinkles, superficial problems etc are all easily handled by both but as the problem gets deeper or more severe a plastic surgeon is the better choice as they are trained in surgery for at least 6 years while a dermatologist may have little to no training in cosmetic surgery. Severe problems as described here typically need a surgical solution.
Under eye "tear troughs"
The dark shadows beneath the eyelids, especially the inside half, can be challenging to improve. Use of the HA fillers such as Restylane and Juvederm can be successful IF performed very carefully, meticulously, and placed properly (usually deep to the slender muscle layer that is there). It is not unusual for some bruising to occur. These injections are best performed by the more experienced physician. Keep in mind that skin color and thickness, aged skin, and presence of fat all can contribute to the under eye shadows and circles. DRC
Fillers Can Be Used for tear troughs
Fillers are a very good means of ameliorating the appearance of tear troughs. My preference, and many others on this site, is Restylane. This is a delicate area, however, and make sure your physician is an board certified dermatologist, plastic surgeon or oculoplastic surgeon.