Which method is safer for tear troughs - Belotero on the orbital with a needle or Vollure superficially with a cannula? (photo)

Question

Did two consults for tear trough area. 1st Dr wanted to inject Belotero with a needle onto the orbital bone. 2nd Dr wanted to inject Vollure superficially with a cannula. Which is method is safer against long term side-effects like nodules and inflammation? So confused with this being a dangerous area for injections! I'm 39, would love your opinions!

Hung William Song, MD · Answer

Tear troughs are very tricky. There are many things that can go wrong including lumpiness and discoloration. As you mentioned if a needle is used, it should be on the bone to avoid injecting into a vessel. Injecting superficially, even with a cannula, can leave unevenness and a blueish discoloration called the tyndall effect. The choice of product does matter, I would stick with beletero or plain Restylane. Vollure may be too thick for this areas. The best option would be autologous fat injection by someone who knows what they are doing. This is and area where you might consider not doing unless your injector is very skilled.

Elham Jafari, MD · Answer

Hi and thank you for your question! As you said, the area under the eyes and tear troughs are sensitive areas that require higher level of skill and attention. I almost always use cannula for filler injection in these areas. Also the placement of filler requires great skill and it is ideally done at multiple layers/planes to achieve the most natural look and many patients also need some additional filler work around the more lateral area toward the cheeks. Lastly, placing hyaluronic acid fillers such as Belotero too superficially can result in bluish discoloration (Tyndall effect) and hence, it should be avoided. I hope it helps and good luck!

Kimberly Butterwick, MD · Answer

I appreciate your question. As a general rule, I tend to administer tear trough injections with a cannula deeply on the orbital bone, because it tends to offer a smoother and safer result with fewer post-treatment side effects. There are many blood vessels near the eye and a cannula is felt to carry less risk of injury to these vessels.The specific type of filler may vary from patient to patient, based on the amount of correction they need and the results they hope to achieve. I recommend looking more at the experience of the doctor performing the injections than the specific filler used although many fillers should not be used in this area as they can cause prolonged swelling and bumps. This area requires a tremendous amount of precision and expertise to treat properly, so experience cannot be overstated in this case.

Mitchel Goldman, MD · Answer

Thank you for your question and I understand your confusion as you try to choose the best practitioner for your treatment. Keep in mind there is no absolute right approach to tear trough filler. Every doctor will have their favorite filler and injection method based on the success they have seen with previous patients. An experienced injector will also know how to tailor this treatment to the precise needs and goals of each patient. I tend to use a microcannula for most of my tear trough fillers since this approach tends to reduce bruising and produce the smoothest results. However, there might be times when I would consider deeper injections with a needle for some patients. I recommend looking at the doctor’s experience, training, and track record when choosing the right treatment for you.

Jason Emer, MD · Answer

there are many options for eyes and fillers in this area should be used to liftt he cheeks AND address the troughs. I like belotero, restyale refyne, and juvederm vollbella to the under eyes and vollure, voluma, defyne and radiesse to lift the cheeks. I think at home dermarolling (see link to eye rolling package from emeragecosmetics.com where we do free skincare consults daily) and peels like enlighten help (along with faith essance serum, restorsea eye serum, sente eye cream).  in office lasers will make a big difference.
There are many things you can do to treat under eye hollows and dark circles. A surgical option to remove skin and/or fat will be the best long term.  However, non invasive less downtime options such as fillers, lasers, microneedling/PRP, cosmelan peels and stem cells can all help give some improvement. I suggest. You get a formal consultation to see what is best for you and your goals.  Best, Dr. Emer.

Amy Y. Paul, DO, FAAD · Answer

Thanks for your question.  I would recommend staying away from Vollure in the under eye area, regardless of technique.  Many of the softer HA fillers such as Belotero and RHA2 can be injected in that area with little risk of future nodules or abnormal outcomes, but a lot depends on the skill and experience of your injector.  I would recommend seeing a board certified dermatologist or ocluoplastic surgeon for your safest outcome.  Please see an expert and best of luck!

Patrick Flaharty, MD FAACS · Answer

The best technique in my opinion is to use Belotero with the cannula technique. In our extensive experience Belotero has been the best tolerated filler under the eyes. We continue to try all the available hyaluronic acid fillers but have consistently had our best results with Belotero. This gives the least risk of post treatment swelling although this can occur with any filler including Belotero. The cannula technique further improves the safety margin by reducing the trauma of needles under the eye. 
No matter which filler you choose you want the procedure done with a cannula which reduces your risk of swelling and bruising.

Matt Tahsini, MD · Answer

Hello and thank you for your question. As with many procedures this is really the doctors preference. Personally I prefer Volure with a cannula. I have several patients that have had great results with this procedure. Best wishes.Dr. T

Nicole DeVincentis | Glowtox · Answer

Hi.  Thank you for a great hot topic question!
I do a lot of tear troughs in my practice and I think most importantly experience is the first most important thing to look for.   The type of filler used, is something the injector will decide based on many factors.  For me personally it is ONLY Belotero or plain Restylane.  I find that other Hyaluronic acids are either too hydrophylic(they pull too much water in) or they ball up and get lumpy which is my experience there with Vollure due to the technology used in making that line of fillers.   
In terms of Cannula vs. Needle-it really depends. I do a lot of needle mostly for the deep work that I want strictly on the bone, and if superficial work is also needed, then I may use cannula.   Each and Every case is unique and will require a custom plan.   Your case though looks very straightforward from what I can see, and I would most likely bolus you with Belotero or Restylane on the bone with a needle.
Best,
Nicole DeVincentis

Richard Ort, MD · Answer

Tear trough injections are a large part of my filler practice. Using a cannula to inject the tear troughs is much better than using a needle. A sharp needle cuts through tissues and blood vessels which frequently causes bruising. A blunt cannula slides through the tissues without cutting. Personally I would never allow someone to inject my tear troughs with a needle.But it’s not just needle vs. cannula. The most important thing is WHO is injecting. If the injector is aggressive with a cannula and jabs it under the skin, it will behave like a needle. Proper cannula injection requires patience, a slower pace of injection, an artistic eye, and multiple gentle passes to get the smoothest results with the least downtime. As far as which filler to use in the tear trough, I usually inject Restylane in a deep, sub muscular plane. This minimizes problems such as puffiness or Tyndall effect. Best,Dr. Ort

Which method is safer for tear troughs - Belotero on the orbital with a needle or Vollure superficially with a cannula? (photo)

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