Tear trough or cheek filler?

Question

I’m trying to decide what to do first. Are there more risks or chance of error involved with either one?

Nima Shemirani, MD · Answer

Hi @Maddirish! 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. The tear trough is more of a risky area. I recommend seeking treatment from an expert injector who has the skill and experience to precisely inject fillers into treatment areas and avoid risks and complications.

Jonathan Kulbersh, MD · Answer

Thank you for your question. If you are concerned about side effects, cheek filler may be the best place to start. This procedure will add subtle volume to your midface, which may help the area under the eyes or make the hollowing more pronounced. If your injector thinks the latter would be the case, you can also do the cheeks and tear troughs at the same time. I typically use a micro-cannula to inject the area under the eyes to achieve a smoother result and minimize side effects like swelling or bruising. With an experienced, qualified injector, you should see excellent results with either or both of these treatment areas.

Scott Trimas, MD · Answer

Actually, you can do both at the same time if you so desire. In my opinion filling the cheeks is separate area of aging from the tear troughs. That being said sometimes when you fill the cheeks itself it can accentuate or make the hollowed areas of the eyelids appear worse. I would see a board certified facial plastic surgeon in your area for consultation. Also, as far as risks themselves, eyelid fillers have more inherent risks than injections of the cheek area due to the proximity to the eye as well as the thinner skin.

Jason Emer, MD · Answer

fillers should be used in the cheeks to lift and then layered with the under eyes. I suggest consulting.

most of my younger clients use fillers to give them shaping especially on the cheeks, jawline, and chin which make the face look more slim and tight; and threads such as PDO or Instalift can build collagen and support the facial shaping and skin looseness over time, slowing down the aging process and given the face a more “snatched” look; and morpheus deep microneedling RF can tighten crepe skin especially on the neck and jawline and is great for long term tightening of the full face, neck and chest; its often used to give the face a slimmer more sculpted look because it tightens the skin and gives lift.  an early face lift can be performed as well even in younger clients if they want a different facial shape, maxillofacial surgery with bone breaking or shaving can also be done.

For facial slimming a combination of treatments are always needed.  Options include:
1. Buccal fat pad removal to reduce fat on the lower face
2. Factite or Renuvion/J Plasma to tighten the lower face, jawline, and chin to reduce fat and give the jawline and neck tightening and shaping.
3. Botox to the masseter to reduce the muscular size of the jaw giving the face an illusion of being more slender
4. Fillers to the jawline, chin, cheeks, temples and brow help to shape the face and make it more angled and defined

Always use at home derma rolling (see link to Emerageskin x anteageMD roller plus stem cells/hyaluronic acid ampules) and peels like emeragecosmetics enlighten or aerify that can be used to improve skin quality and tighten the skin while improving wrinkles, pigmentation, acne, and Melasma.

See an expert who does facial shaping with surgical and non surgical methods to get a comprehensive option.  Best, Dr. Emer.

Nelson Lee Novick, MD · Answer

The cheeks serve as a support and buttressing for the under eye region, and loss of volume in the cheeks, therefore, is often the primary reason for the development of tear trough hollows. Accordingly, simply restoring appropriate volume to the cheeks not only helps to reestablish a more heart-shaped face, but diminishes the tear troughs and creates a smoother transition between the upper cheeks and the under eye region, often without any need to directly treat the tear troughs. Make sure that you consult with a board certified aesthetic physician and of course ask to see his/her personal before and after photos before agreeing to proceed. Best of luck.

Michael A. Persky, MD · Answer

Hello Maddirish,
I recommend treating your cheeks first as this also helps with your tear trough.  After treating your cheeks, you may not need treatment of your tear troughs.  Tear trough injections are more likely to result in bruising and have greater risk of complications.  Most importantly, choose your injecting physician very carefully.  Good luck and be well.
Michael Persky, MD
Encino, CA

Anshul Gambhir, MD · Answer

Thank you for your question! Tear trough filler has a higher risk of bruising, lumps, and tindle effect (a bluish hue from the filler). I would suggest starting with cheek filler which has lower risks of all the above. Hope this helps!