Is there any type of filler for the upper cheek and eye trough that will not draw too much fluid to the eye?

Question

I have had fillers under my eyes in the past, but they always look good for about three weeks and then start creating bigger bags under my eyes than what I had before. Is there any filler out there that will help give that lifted and smooth look under the eye, without creating too much fluid under they eyes? My mid cheek area has also started to deflate slightly. I do have a history of seasonal allergies and have tried Perlane, juvederm, and restylane in this area before. Thank you in advance!

Nima Shemirani, MD · Answer

Hi @Pinkwillow. Most facial filler products that are injected into this area should ideally be placed in the tissue plane directly on top of the bone, or at least underneath the eyelid muscle layer. If a facial filler product is placed too superficial in the skin, or on top of the muscle layer, the product may settle in with an abnormal appearance and can look to be lumpy, swollen, or irregular. Restylane, Juvederm, and Belotero work great for the Tear Trough. Best of luck!

Mehryar (Ray) Taban, MD, FACS · Answer

For the cheek, one can use Radiesse as safe filler with least water retention property.  For the lower eyelids, it might be best to use Belotero or Restylane.  The amount and location of the filler injection matters too.

Harold J. Kaplan, MD · Answer

Hi PW.  While we do not know your case, it is possible that the puffiness you see is due to the injection technique rather than the filler used.  We use Restylane exclusively under the eyes as it just works best with that area.  We also use a deep injection technique "under the muscle".  When the product is placed too superficially it can look like your bags got bigger and the product is lumpy.  Perhaps it's time for a consultation with another injector.  For examples of before and after photos of Orange County, CA patients that have had dermal fillers under the eyes, check the link below.

Sirius K. Yoo, MD · Answer

Thank you for your question.  You bring up important considerations.  The lower eyelids show even a hint of overfill and this can happen from the filler absorbing water after injection.  While there are certainly very skilled injectors that use Juvederm (often diluted) and underfill initially with the understanding that it will plump further, in my opinion, this is still less precise than getting it right while the patient is still in my office.  I prefer to use Belotero (Restylane is also a very good product that does not absorb water after injection).  Both are silky smooth and don't form lumps with proper injection technique.  In regards to your cheeks, you have several options here as the injection is done considerably deeper and thus the results are more forgiving than around the eyes.  Voluma or Radiesse are common products to place in this area and can give you the volume replacement you desire.  I have taken to blunt tip cannulas for this type of injection to reduce post injection swelling and bruising.  Best of luck!

Jason Emer, MD · Answer

Juvederm Voulma has very little water retention and has great lift/hold.  I suggest trying this as it is approved for mid-face/cheek rejuvenation.  Off-label treatments in the trough of the eye, work very well in small quantities.  Best, Dr. Emer.

Steven M. Daines, MD, FACS · Answer

Restylane and Belotero are your best options for under the eyes. For the cheeks, Scuptra, Radiesse, and Voluma are great options. Another factor to consider is the skill of the injector. The product will not have the desired result if not injected correctly. Choosing an injector with an intimate knowledge and familiarity with the surgical anatomy of the lower eyelid and midface is critical to achieving a natural, safe result.

Sheryl D. Clark, MD, FAAD · Answer

Patients who have a tendency to get puffy under the eyes even without fillers, or after fillers, have a problem that can be difficult to treat.  Beletero is the least likely to draw water to it, and should be placed deeply with a blunt-tipped cannula, for best results. Voluma wil help the volume of the upper cheeks and is unlikely to add to any swelling. You may even wish to have this done, as this filler sometimes helps tear troughs by redraping the skin.

Edmund Fisher, MD · Answer

Fillers around the eyes need to be thin density and inherently hydrophobic (doesn't attract water) to avoid the least amount of puffiness in this area. The eyelids have the thinnest skin in the body so this area is the most unforgiving for bumps and other irregularities. For this reason, Restylane and Belotero are best. Beware of injectors more concerned with Allergan corporate rebates that will try to use Juvederm in this area. Juvederm is the most hydrophillic filler which makes it well suited to the lips but not the eyelid area.  Because of the expertise required around the eyelids, see a well reviewed injector, preferably referred by someone who has had the procedure already.

Stephen Weber MD, FACS · Answer

Voluma is typically a very nice option for the issues that concern you. It is injected along the cheekbone and in the apple portion of the cheek, depending upon where the volume loss is most pronounced. It also has the effect in many patients of softening the nasolabial fold area and the tear trough. It draws in almost no water and it's not actually placed in the undereye area and should avoid the issues you've experienced before. I hope this information is helpful for you.Stephen Weber MD, FACSDenver Facial Plastic Surgeon

Is there any type of filler for the upper cheek and eye trough that will not draw too much fluid to the eye?

Answers (9)

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