Best filler for tear troughs that extend to upper cheeks.

Question

I had a syringe of restylane in my under eye area 9 months ago. 1 syringe dint give me total correction and my doctor said i hage fairly deep tear troughs that extend to my upper cheeks. Now 9 months later , the result is almost gone. I have consulted another doctor, she said i should go for Juvederm ultra plus this time as this lasts longer . Is it a better filler for under eye area? Or any other filler which would give me more long lasting effects ?

Vito C. Quatela, MD · Answer

In my experience, tear trough injections using hyaluronic acids injected directly onto the bone have yielded the best results, with the least amount of the Tyndall effect. I would not use Juvéderm® under the eyes. My preference in that area is a thinner hyaluronic acid such as Restylane® or Restylane® Silk. Nevertheless, the issue may not simply be the choice of filler, but your doctor must also consider its placement, as well as its effect on the rest of the face. Because of this, you may find that you would like something more than just tear trough augmentation, such as mid-face fillers, to balance out the rest of the face with the lower eyes. Occasionally, hyaluronic acids are not enough, and fat injections, or even a submalar implant may be used for a better result.

Daniel Ezra, MD, FRCS · Answer

Its been very interesting to read the wide variety of advice you are being given. Filler practice is evolving all of the time, with new fillers on the market. What you actually need is two different fillers: one for the tear troughs and another for the cheeks. Anyone who uses the same filler all over the face is doing something wrong,
Latest research and licensing points to Teosyal Redensity II or Belotero for the tear troughs. For modern practice, these are the only 2 that should ever be used for the tear trough. The cheeks are quite forgiving snd restylane or Juvederm would be fine.
Good luck with your treatments.

Nelson Lee Novick, MD · Answer

Photos would have been extremely helpful. In general terms, experienced injectors attempt to accomplish two goals when treating the under eye (intraorbital) region with fillers. One is to create a smooth, seamless transition between the upper cheek and under eye regions. The next is to directly address any remaining tear troughs, hollows, bags and dark circles directly under the eyes. For improving the cheek/lid junction, a volumizing filler, such as Voluma XC may be used to supply the necessary cheek "scaffolding" to help improve the cheek/lid junction and Beletoro Balance (which has little to no tendency to give rise to the unwanted, bluish Tyndall Effect when injected superficially into the delicate undereye tissues) may be used for the tear troughs. I use the latter two for these purposes in my Manhattan office and Stylage XXL and Teosyal Redensity II, respectively, in my Israel satellite facility, where a far greater number of regulatory agency approved fillers and volumizers are available). I do not use Juvederm products directly under the eyes, since they are prone to attracting a good deal of tissue fluid and may actually give rise to bags and swellings. I also do not use fat for this purpose, since fat cannot be easily be removed and may give rise to lumps and bumps, which are very difficult to treat. Make sure that you consult with a board certified aesthetic physician and insist upon seeing her before and after photos before agreeing to proceed. Best of luck.

Nelson Castillo, MD · Answer

Thank you for sharing your excellent question.  If you are looking for a longer-lasting result I would advocate placement of Juvederm Vollure.  This product is soft, matures quickly, and has limited swelling time.  Placement with a cannula also affords little downtime and bruising risk.  Hope this helps.

Mitesh Kapadia, MD, PhD · Answer

Patients who need fillers in the tear trough area often also need fillers in their upper cheeks. For most patients the goal is to improve the eyelid-cheek junction and reduce shadowing in this area. Juvederm Ultra and Ultra plus are hydrophillic fillers, which means they attract water and increase in volume after injection. It is sometimes difficult to judge how much these fillers will expand, which can lead to overcorrection. Restylane and Restylane Silk are much better products to use in the tear trough area as they do not attract water the same way. I often blend lower eyelid and tear trough fillers with Restylane Lyft or Voluma in the cheeks. In a small number of patients, Juvederm Ultra and Ultra Plus can also attract additional water as the products break down leading to a puffy, swollen look several months after injection. This is rarely seen in areas with thicker skin, but can look really awful when this reaction occurs around the eyes. Juvederm Ultra and Ultra Plus are great fillers especially for the lower face - I just dont like to use them around the eyes. In most patients, under eye fillers last 1-2 years or more. Even if your body tends to metabolize the filler more quickly, I wouldnt recommend switching products for the reasons I describe above.

Richard Wellington Swift, MD · Answer

Thank you for posting your interesting tear trough question. Most of the aging around the lower eyelid is due to bone loss and remodeling of the eye socket. Restylane is a hyaluronic acid with works best when injected along the orbital rim blending the lower eyelid and cheek junction. Restylane can last up to 1 year when injected along the tear trough and produces natural results. I do not recommend any Juviderm injections to the lower eyelids. This is an advanced filler injection technique and requires an experienced well trained injector. I recommend that you have a consultation with a Board Certified Plastic Surgeon who is highly experienced with this technique and produces consistent natural beautiful results. Best wishes, Dr. Richard Wellington Swift, MD

Steven Wallach, MD · Answer

6-9 months is about right for how long restylane lasts.   I would avoid the thicker products around the eyes, because it may lead to more risks of lumps.

Leonard Grossman, MD · Answer

The the single best filler for treating tear troughs and/or hollowness of the Cheeks is the patient's own fat. It's natural, no reactions of any kind, it gives you a permanent result and in good hands nothing beats it. I use Restylane in the lower eyelid cheek Junction only as the last resort since Juvederm is not as good a product in the lower eyelid.Good luck from New York City

Bruce E. Katz, MD · Answer

Thank you for your question. For tear troughs, I would recommend Juvederm Ultra or Restyalne Silk. They are FDA approved and safe. For more information, I recommend getting a in person consultation from a board-certified dermatologist.

Best filler for tear troughs that extend to upper cheeks.

Answers (9)

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