Where Should Juvederm Be Injected when Trying to Fill the Tear Trough (Under Eye Area)?

I'm 32 & have slight "hollowing" underneath eyes. I had Restalyn a year ago under my eyes & other then bruising was pleased. It was injected into the tear trough & I saw beautiful immediate results. I went yesterday to a dermatology clinic & dermatologist recommended that his anestitician administer juvederm as it's superior to restalyn. Anestitistian kept injecting the top part of my cheek. I now have a big marble in my cheek & under eyes look worse. Was this the correct place to put juvederm?

Doctor Answers 8

Tear trough injections with fillers juvederm, restylane

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Fillers are a great tool in the arsenal against facial aging.  I generally recommend it for subtle results in people who are starting to show mild forms of aging.  If done to multiple areas and in combination with topical agents and botox a so called  liquid facelift can be achieved.  I find all of these avenues are ideal to delay a more invasive surgery until later.  Unfortunately they can get expensive and the duration can be relatively short.  The tear trough is probably the trickiest area to inject and has the most feared complication.  I generally steer patients away from injections in this area but it can be effective.  I always do my own injections as the anatomy of the face is very complicated and not even taught to an aesthetician.  The skin of the lower eyelid is so thin that a superficial injection is just asking for trouble although some times people can get away with it.    

Juvederm and tear trough

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The best way to correct the shadowing from a deep tear trough is to inject deeply along the orbital rim directly under the tear trough.  It sounds like your original injector did it right and the aesthetician did it wrong.  This emphasizes the importance of going to a skilled, experienced injector.  Results are very technique-dependent.

The importance of a physician doing your filler injections

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Because this is an art as much as it is a science, it is especially important to remember that the experience and technique of your physician injector is the most critical part to your achieving a beautiful, natural result. You should never have anyone other than a physician do your filler injections. From your description it sounds as if the aesthetician injected you improperly. In many states it's not even legal for aestheticians to do filler injections.

Mitchell Schwartz, MD
South Burlington Dermatologic Surgeon
4.4 out of 5 stars 13 reviews

Proper injection location for fillers in the tear trough area.

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The proper location for injections in the tear trough area is deep just above the bone and injections can extend to the area  just below the orbital rim.

Ted Brezel, MD
Long Island Dermatologic Surgeon

Juvederm to cheeks...

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I do not recommend Juvederm to the Tear Trough area!!!  Restylane is the only injectable I use for this area.  Cheeks area a different story... Juvederm can be placed in the cheek area for volumization.  Everyone has different techniques and I would say if you are unhappy with your result there is a product called hyaluronidase that can dissolve it. 

Good luck.  Hope this helps.

Dr. Grant Stevens        

Grant Stevens, MD
Los Angeles Plastic Surgeon
4.7 out of 5 stars 152 reviews

I prefer Restylane for the tear trough under the eyes over Juvederm

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For most areas of the face I prefer Juvederm. I find it's a little smoother and more moldable over the immediate post injection period. Around the eyes I like Restylane better. Both are hydrophilic, which means they absorb water. Restylane does it more intensely over the first day or two. Juvederm more slowly. For some reason, around the eyes I have seen swelling come and go in patients after Juvederm many months later. Never with Restylane. Initially, more swelling but then that's it. This doesn't occur elsewhere in the face.

Where do I put it? I inject right on top of the bone in the tear trough area and do the injections myself. Occasionally if there is a superficial dent or fold I might put a very tiny bit more superficially. It is the more superficial injections that are more prone to looking lumpy given the very thin skin of the eyelids.

Steven J. Pearlman, MD
New York Facial Plastic Surgeon
4.9 out of 5 stars 141 reviews

Filler in tear trough

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I prefer to inject fairly deep and my preference is restylane. I think it is a bit more malleable and easier to use in this tough area.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Should be injected deeply

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Hyaluronic acid fillers need to be injected deeply near the bone of the cheek to prevent the complication you describe.  Often injectors not comfortable with the anatomy around the eye area will inject too superficially, leaving a bump that is present under the skin.  Providers can use hyaluronidase enzyme to help remove filler that has been injected at the wrong depth.  However, this is off-label.

Jay Zimmerman, MD
Walnut Creek Dermatologic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.