Should I get more tear trough treatment? Look worse after filler. (Photos)

Question

I recently had fillers done to remove my tear toughs however I feel that they actually look a little worse now than they did before on one eye particularly! My left eye in particular has always been worse than my right eye- I only started noticing my tear toughs as i started losing weight a few years ago however it seems to have been getting worse over time. I am due to go to back to my doctor for a check up, should i request more filler? Thank you

Mehryar (Ray) Taban, MD, FACS · Answer

You have under eye fat bags along with tear trough hollowness. I need to evaluate your eyes in consultation but you may do better with transconjunctival lower blepharoplasty with fat bags repositioning. See following video.  I recently published a manuscript discussing performing lower blepharoplasty on patients with prior under eye filler injection. You can find the manuscript on the link below too.

Daniel Ezra, MD, FRCS · Answer

Although difficult to assess from a photo, it appears that you have developed swelling after the injection. Swelling can occur with all fillers as water is drawn into the molecular gels, but this effect is typical when injectors use standard fillers in this delicate area.  There are specialised fillers that should be used, but unfortunately most doctors will use the same fillers for the whole face. Infact, different fillers should be used for different areas. If more highly cohesive fillers are used (as one would in the cheeks, nasolabial folds etc, this result is not uncommon. I would have this discussion about filler choice with your doctor, and would  not recommend more filler. Best of luck with your future treatments.

Philip K. Robb Jr., MD, FACS · Answer

your left eye does attract some attention- without before photos and a good examination, it's difficult to tell if you need more or if this is too much- when you had the treatment is also a factor as some swelling can occur afterwards. 
Hope this helps and God Bless!
Dr. Robb

Janet M. Neigel, MD · Answer

Your cheeks are quite flat.  You have lost a great deal of volume from your cheeks.  Most likely from losing weight.  I would recommend injecting your cheeks with Voluma or Restylane Lyft.  In addition, you most likely need a lower lid blepharoplasty.  However, I would not neglect the loss of volume you now have in your cheeks.  Best of luck!

Shaun Patel, MD · Answer

It's important to know how long ago you had the treatment and which filler was used. If the treatment was recent, we may still be looking at normal post procedure swelling which can take up to two weeks to resolve. My preferred filler for the undereyes is Restylane and I inject it using a microcannula to minimize swelling and bruising. I do not recommend that Juvederm be used under the eyes because of its propensity to attract water molecules which results in prolonged swelling.

Paul C. Dillon, MD · Answer

I believe that the major issue is not the depression (trough) but the budge above the deprrssion. My recommendation would be to consider a lower blepharoplasty.

Clifford Albert, MD · Answer

Hard to answer without knowing how long ago these were treated and what was used.the retaining ligaments are circular around the eye and create a pocket that can hold in some swelling for a few weeks after an injection.HA fillers are essentially sponges that hold in water and cause a filling effect.Radiesse is composed of calcium crystals and doesn't cause a swelling effect so I like it for this area. I would gently massage the area laterally about 10x in the morning and night to help dissipate any swelling.should improve within 2 weeks

Should I get more tear trough treatment? Look worse after filler. (Photos)

Answers (7)

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