Injector said I need cheek fillers rather than tear trough? Advice? (Photos)

Question

I’m 39 years old; I have dark circles & beginning signs of bags under my eyes. I visited Beauty Fix Med Spa on the Upper East Side of NYC & the woman giving me the consultation, along with the injector, said I would not be a good candidate for tear trough fillers; they said cheek fillers would improve the bags under my eyes. So I got a half ml of restalyn in each cheek. I do not see much of an improvement... was I advised wrong or is a half ml, not enough cheek filler to improve my bags?

James M. Economides, MD, FACS · Answer

It’s understandable that you’re concerned about the lack of improvement after your treatment. Here are some factors to consider:

1. Cheek Fillers for Under-Eye Bags:
Why Cheek Filler Was Recommended: In some cases, under-eye bags and hollows can be caused by volume loss in the midface (cheeks). Restoring volume to the cheeks can provide a subtle lift and reduce the appearance of under-eye bags indirectly by improving the transition between the cheeks and the lower eyelids.
Half a Milliliter: Half a milliliter in each cheek is a relatively small amount of filler. While it may provide some lift, it might not be enough to significantly affect the appearance of your under-eye area, especially if you have noticeable bags or hollowness. Typically, cheek augmentation requires more volume for a noticeable change.
2. Tear Trough Fillers:
If the primary issue is under-eye hollows or bags, cheek fillers alone may not be enough. Tear trough fillers specifically target the area under the eyes and can improve the appearance of dark circles and bags. Some patients are not ideal candidates for tear trough filler due to thin skin or puffiness, which might be why the injector recommended against it.
3. Further Treatment:
Additional Cheek Filler: If the injector felt that cheek volume loss was the primary issue, adding more filler to the cheeks might help improve the appearance of the under-eye area. However, overfilling the cheeks can sometimes make the face look unbalanced, so it’s important to proceed cautiously.
Alternative Treatments: If you’re still unhappy with the results, consider discussing other options with your provider, such as under-eye laser treatments, microneedling, or PRP (Platelet-Rich Plasma) for under-eye rejuvenation.

Kenneth R. Francis, MD, FACS · Answer

Dear Daenerys,
Tear trough correction is a very challenging condition for aesthetic providers.  There are many ways to approach them, one of which is cheek revolumization.  This tactic usually requires a greater amount of filler material to obtain a correction.  There is some improvement in your tear troughs even with such a small amount of filler.  You probably just didn't receive enough.  Good luck!

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