Tear trough fillers NJ/NY. (photo)

Question

Hi, I am looking into fillers for the tear trough area. I had fillers under my eye, but I am still not completely happy. 1) do you think I need it or would I benefit from something else? 2) does Anyone know of any experienced doctors in the nj/ny area? Thanks!

Nima Shemirani, MD · Answer

Hi @miol2010. Thank you for sharing your photos. You would be a great candidate for tear trough 
fillers. Restylane and Belotero work great.  I recommend seeking treatments from expert injectors who have the skill and experience to precisely inject fillers into treatment areas and avoid risks and complications.

Best of luck,

Dr. Nima

Nelson Lee Novick, MD · Answer

Tear trough deformities are quite routinely treated with fillers these days. Fortunately, we have come a long way from the late 1980s when I first began treating tear troughs with the original Zyderm I collagen, which was all that was available in those days. Today, we have a number of hyaluronic acid products that can be used for this purpose, including a dilute form of Restylane and my current preference, Belotero Balance. The advantage of Belotero is that its proprietary manufacturing process gives rise to an injectable filler, unlike the rest, that has little likelihood to cause the unwanted, bluish Tyndall Effect when injected superficially into the delicate skin under the eyes.While it is unclear why your results were not gratifying, it is very important that you seek consultation and treatment by a board certified aesthetic physician with extensive experience and expertise in treating this important and delicate area. Tear troughs should not be treated by inexperienced injectors who may have learned how to inject fillers into smile lines at a weekend seminar. Make sure that you ask to see befores and afters before proceeding with any physician.

Sheryl D. Clark, MD, FAAD · Answer

You look fairly young, but unfortunately, dark circles or deep tear-troughs can be a problem at any age. They can be due to any or all of 5 factors:1. Shadowing from congenital or acquired (via bone and fat resorption as we age) volume deficits2. Rubbing the eyes, for example, if one has allergic conjunctivitis or atopic or contact dermatitis, which can cause the skin to hyperpigment3. Thin skin, usually from aging and/or sun exposure, which allows the tiny blood vessels to show through4. A defective orbital septum, which allows fat to protrude and therefore creates a shadow5. Excessive stremgth of the medial fibers, nearest the eye, of the periorbital muscle, such that when one smiles, a shadow is created from the bunched-up fibers.Only an in-person evaluation can determine which factors are operative in your case, but each can be treated successfully. If the first cause is part or all of the problem, Restylane or Beletero may help. The second and third factors can be treated with topical retinoids and antinflammatories, and addressing any allergies or irritants. The fourth factor is best treated through plastic surgery, although I have seen patients who do not wish to have surgery improve with dermal fillers. The last factor can be mediated with just 2 to 4 units of Botox. Based upon your photo only, the first and possibly the fifth factors may be contributing to your problem. I would be delighted to see you inconsultation so that the causes and relevant treatment(s) can be discussed.All the best, Dr. Clark

Sean Freeman, MD · Answer

miol2010, consider a "SOOF lift blepharoplasty" versus fillers. Fillers do carry a risk of blindness when injected around the eye, very rare but needs to be understood. Good luck!

Tear trough fillers NJ/NY. (photo)

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