Tear trough or mid cheek filler? (Photos)

Question

I am a 38 year old. I am extremely bothered by permanently looking tired, no matter how much I sleep, exercise, drink water, etc. I would like filler under my eyes. I cannot afford both tear trough and mid cheek so need to choose one. Which would give me the most immediate result?

Jason Emer, MD · Answer

Fillers like Belotero, Volbella, and Restylane Silk are good for improving under the eyes, but keep in mind that a combination approach will give the most improvement. My patients try to get non-surgical treatments to avoid surgery, so we use fillers, lasers, microneedling/PRP and stem cells. I suggest consulting with an expert to develop a treatment plan best suited for you. Best, Dr. Emer

Nima Shemirani, MD · Answer

Hi @morrisamorrisa! The upper cheek is a major support for the under eyes. I would first begin with addressing the volume loss in the cheeks followed by addressing the tear trough area.

Toby Mayer, MD · Answer

Best filler for mid face and tear trough. Voluma placed well will do both and lasts up to 2 years  Fat is irregularly Irregular and can leave bumps which can’t easily be removed  Therefore I don’t use it in this location

John Tang, MD · Answer

Thank you for submitting your photos.  I would recommend that you consider using Restylane underneath the eyes which is where most of the volume loss is.  There is some extension of volume loss in the front of the cheeks which will need some filler as well.  Looking tired happens when you are eyes are hollow.  If done correctly by a skilled injector, there is no lumpiness and they eyes will look smoother and rested.  The key is finding someone who can deliver the results which is crucial.  Best of luck!

Gregory A. Buford, MD, FACS · Answer

Thanks for a great question!  I will politely disagree with the previous PS and suggest using an off-the-shelf filler to address your concerns.  While fat is a very nice filler, no type of grafting procedure can assure 100% take and so this can be a little unpredictable.  Also, in the tear trough area you have to be very careful with lumpiness.I would personally begin by injecting your cheeks.  Your mid face is flattened and would benefit from volume in this area instead of the tear troughs.  I would use 1 syringe of Voluma XC/cheek to assure a more optimal result.  And while fillers like Voluma are not permanent, they do last up to 1.5 years and provide a very natural looking result.I hope this helps and wish you the very best!Warmest regards,-Gregory A Buford MD FACS PCEOBoard Certified Plastic Surgeon and Published AuthorCertified Allergan National MASTER Facial Injectables Trainer

Center for Aesthetics and Plastic Surgery - Grand Rapids · Answer

Hello there,
     I would definitely start with mid-cheek. You also may be a good candidate for Sculptra since we can treat the whole front of the face entirely. Just make sure you are utilizing an experienced provider since there are several large vessels that travel through this region, making it an area that requires caution. Based on your photo, two syringes would be a good starting point, and I would recommend a softer filler like Voluma to start. 
Hope this helps. 
Sarah RN BSN

Julie Shelley, DO · Answer

Thank you for your question and pictures! If you had to choose one area to treat to give you the best results, I would recommend hyaluronic acid filler in the mid-cheek, such as Voluma or Restylane Lyft. This will add volume to your flattened antero-medial cheek area and will also likely improve the appearance of dark circles in the tear trough area. You can always have tear trough filler placed with a hyaluronic acid filler such as Restylane-L at a later date if you do not get all of the improvement you are looking for with mid-cheek filler. I recommend seeing an experienced aesthetic physician for consultation. I hope this helps!- Dr. Julie Shelley

Morgan Rabach, MD · Answer

Mid cheek filler along with restoring volume (slight amount) under your eye area would make a tremendous difference. 
Your skin is beautiful you just need volume to the areas that are depleted. 
Depending on what fillers you receive they have a very long lasting result. 
I think you would be please with Restylane under the eyes and Volume for your mid cheek area...when you are ready!

Jo Herzog, MD · Answer

If I had to pick one place to fill I would start with your cheeks.I have found that filling the right areas of the cheek often "pulls out" the problem area under eyes and patient no longer needs filler under eyes. I would choose Restylane Lyft or Radiesse for this.

Leonard Grossman, MD · Answer

The best filler for the tear troughs is the patient's own fat. When fat grafting is performed by an experienced plastic surgeon, the results are permanent and natural. Second filler that can be used in that area is Restylane but it must always be done in underfilled fashion so as not to create further bag formation. I hope this helps and good luck from New York City plastic surgery

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