Can Genetic, Hollowed Tear Troughs Be Corrected with Dermal Filler, with Low to No Risk of Development of "Bags"? If So, Which?

Question

Since I was a child I've had markedly dark lower lid area. Mostly on the inner-most quarter. From early adulthood onward my background has often been mistaken as Indian, though I'm of Mexican and Mediterranean mixed blood. Since aging onset, this area has expanded to the outward most quarter, to near the height of my pupil. My biggest concern with any dermal filler is overcorrection, or the formation of bags/festoons. If can be corrected, would it be best to start with few IU of hyaluronan?

Mitesh Kapadia, MD, PhD · Answer

This is a common problem in many ethnic groups which is well treated with Restylane injections. Formation of festoons is not a common problem as long as there is not a significant amount of loose skin.

Mehryar (Ray) Taban, MD, FACS · Answer

Dermal fillers are an excellent treatment choice for under eye dark circles or hollowness. However, the result depends on the technique of injection, amount of filler and type of filler injected. The best fillers to use are of the hyaluronic acid gel variety since they are reversible. They include Belotero, Restylane and Juvederm.

Larry Fan, MD · Answer

Dear davidtorrette,

	Lower eyelid and tear trough hollowing are common cosmetic concerns that can be improved using injectable fillers such as Restylane and Juvederm.

	Some patients, however, may be better candidates for other treatments such as fat grafting or lower blepharoplasty. Accordingly, it is important to see an experienced provider who performs the full range of cosmetic treatments ranging from injectables to surgery.

	It is also critical to find a skilled and experienced injector, as the eyes are a very delicate region.

	Please see an experienced, Board Certified Plastic Surgeon or Facial Plastic Surgeon to discuss your concerns.

	Warmest wishes,

	Larry Fan, MD

Kimberly Lee, MD · Answer

The tear trough hollowness is a common area of concern with patients. Dermal fillers can help improve this area but it is dependent on the skill of the injector, not necessarily only the type of filler used. It would be unusual to develop festoon from dermal fillers if properly injected. Please consult with a board certified specialist who can assist you with achieving the results you seek.

Richard W. Fleming, MD (retired) · Answer

You have a groove in the tear troughs and this extends at the margin of the entire lower eyelids. Success will depend not on the filler injected but the technique of the physician. If you are terribly concerned about bags or festoons use Restylane which can be reversed with the injection of an enzyme.

Can Genetic, Hollowed Tear Troughs Be Corrected with Dermal Filler, with Low to No Risk of Development of "Bags"? If So, Which?

Answers (5)