Age 35, tear trough Juvederm filler, how much needed? (Photos)

I have been treating the under-eyes with fillers for more than three decades. Back then, if the tear roughs and bags under the eyes were the problem, we simply treated the under-eyes directly with filler. However, with increasing understanding of the anatomy of facial aging, about fifteen years back, we realized that volume deficit in the upper cheek region was a major contributor to the development of the tear troughs and bags, much as loss of cheek volume is a major player in the formation of the smile lines below. And since the upper cheeks are such a major support to the under-eye area, sophisticated, experienced injectors, when addressing tear trough issues, typically look first to using a robust HA volumizing filler to the upper cheeks. Not uncommonly, this may be all that is needed to remedy the issue. But, if still necessary, a low viscosity, cohesive, malleable HA filler may be then directly injected into the tear trough regions to further refine the aesthetic effect. I would be concerned about the use of plain Juvederm under the eyes, as this filler attracts a good deal of tissue fluid to it, which may result in a very undesirable puffiness. Make sure to consult with an experienced cosmetic dermatology injector, since the under-eye region is not the location for the hands of novice injectors accustomed to using plain Juvederm or simple Restylane for smile lines. Hope this helps. Best of luck.

Hello, and thank you for your question. Based on the photo, you are potentially a candidate for tear trough filler. Without seeing you in person, it is difficult to determine. The amount of filler can vary from person to person. Some treat with one syringe per eye, others use one syringe to treat both eyes. By placing product in the cheek, this can inadvertently help the tear trough area and may require less product. I would suggest speaking with your provider to make sure the amount and type of product is appropriate for your aesthetic goals.

Tear trough filler is for candidates with hollowness under the eye area. The cannula technique is ideal to minimize bruising. The only Juvederm product that is FDA approved for use in the tear trough is Volbella. The gold standard HA filler for under the eye is the original Restylane (Restylane-L). Based on your photos, you appear to be a great candidate for tear trough filler.

Depending on your complete set of goals, there are a number of dermal fillers that could be a good fit for you. Most commonly, we recommend Restylane-L for restoring volume under the eyes and Restylane Contour for restoring volume to the cheeks. The Restylane-L formula is specifically designed to subtly restore lost volume to sensitive skin, making it an ideal option for a natural, nuanced look around the eyes. Especially for patients who are seeking more dramatic results, Restylane Contour is a great option for treating the cheek area: formulated with XpresHAn technology, it is designed to restore substantial shape and volume and in fact, was specifically developed (and FDA approved) for cheek augmentation.
While these are our most common recommendations for the issues you’re addressing, they are not the only ones: the dermal filler we choose depends heavily on the patient’s unique skin type, the intensity of results desired, and their complete set of goals.

You should have some improvement to the tear trough area with filler, but it will not provide the same result as a lower blepharoplasty. I do encourage you to also address the cheek area as it will improve the overall contour. Typically one syringe for each eye is a good starting point not including the cheeks. The wonderful thing about fillers is that you can go slowly and build up to the look you want. Be sure to see an expert injector for treatment.

If you find a plastic surgeon, who specializes in fat grafting, they can rebuild your lower eyelid and cheeks, which are probably hollowed or flat with the use of your own fat. The same thing can be done to the upper eyelid/eyebrow, which have lost a great deal of volume as a person ages or due to their genetics and weight loss,. With the use of your own fat, your healthy and youthful, looking eyebrows and eyelids can be restored or made to look even better than when you were much younger. With a properly perform technique, the results should be practically permanent and natural. Have a look at photographs of patients like yourself in our file. I hope this helps and good luck from New York Cit Plastic Surgery.