Best Approach for my Tear Trough Hollowness? (photo)

I am becoming increasingly concerned about the deepening depression in my undereye area. I have previously had Juvederm injected to the upper cheekbone area to correct the long creases that had extended downward across my cheeks (nasojugal?). However, I am now noticing that the correction of this area seems to be exaggerating an undereye hollowness that was less detectable when my upper cheek area was less pronounced. Would Restylane be the best option to help "blend" these two regions?

Doctor Answers 18

Lower Lid Depression Correction

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The depressions that cast shadows of your lower lids can be improved with implants, fillers or fat preserving blepharoplasty either transconjunctival or incision beneath lash line approaches. Implants were very popular a decade and longer but because of less invasive techniques they have fallen out of favor by the majority of surgeons for tear trough correction.
Regarding fillers:. In this area it is very important to have an experienced injector so as not to place the filler too close to the skin. I would recommend trying Jeuvederm or Restylane first as they are not permanent and can be reversed if you do not like the result. If you do like the result, then fat transfer is a good option for a more permanent correction. The blood supply to this area is very good and the survival though differs from person to person has been estimated at 75-85% in this area.

Restylane for Tear Troughs

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   Restylane to blend the periorbital areas is a reasonable choice and probably produces a better result than Juvederm, Radiesse, or Sculptra.  Belotero may also be appropriate, depending upon goals.

Approach to tear troughs

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I think some restylane would be very helpful for reducing your tear trough. Juvederm is another option, and less commonly radiesse or sculptra can be injected here depending on the experience and preference of your chosen dermatologist or plastic surgeon. Regular injection technique by an experienced and trained physician is the typical approach, while cannula treatment is newer and less common, but may cause less bruising.

Benjamin Barankin, MD, FRCPC
Toronto Dermatologic Surgeon

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Best option for filling the tear trough

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Restylane is the filler I prefer to use for the tear trough. When the injections are performed properly, it yields a fantastic result. I would recommend a consult with an experienced physician. Thank you, and please feel free to ask any additional questions. I would be happy to answer them for you. 

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Restylane is Filler of Choice in Peri-Ocular Region

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Thank you for your question.  I agree with your assessment.  Restylane treatment deep to treat the tear trough deformities should put things into better balance.  It is important that the filler be placed deep with a blunt tip cannula to prevent complications.  Additionally, I would recommend that restylane be used. This filler absorbs less water than juviderm, thereby causing less swelling.  Good luck with your treatment!

Restylane for your tear trough

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You may require a tiny amount of Restylane in the tear trough area.  It should be injected by an experienced board certified dermatologist or plastic surgeon for best results.

Martie Gidon, MD, FRCPC
Toronto Dermatologist

Radiesse Combined With Belotero Balance Works Well For Hollows Under the Eyes

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Combining Belotero Balance, Restylane L, or Juvederm UltraXC with a small amount of Radiesse works well for hollows, tear troughs, and dark circles under the eyes

Tear troughs, hollows, and dark circles are common problems of the lower lids. It has become standard practice to treat this region with lighter weight fillers, like Juvederm or Restylane, to lift, straighten, and contour this region. Occasionally, if fillers are inadvertently placed too superficially, a bluish discoloration related to light scattering (a phenomenon known as the Tyndall effect) can occur, which can actually make the dark circles more prominent. Belotero Balance, a new hyaluronic acid product, has been manufactured to avoid this. However, I have found that the addition of a tiny amount of Radiesse, a whitish-colored filler, to Belotero, Restylane L, or Juvederm UltraXC, to be an excellent way of treating tear troughs and hollows and lightening existing dark circles. However, only an experienced, board certified aesthetic dermatology or plastic surgeon injector should attempt to treat this area in this fashion.

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Restylane to efface the nasojugal groove

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Restylane is an excellent choice for improving the lid-cheek junction (nasojugal groove).  By replacing the depleted volume in this area, a youthful contour can be restored.  Juvederm tends to be more hydrophilic (attracts water) than Restylane, causing the results to be a bit less consistent.  

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Restylane in Tear Troughs

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Restylane is the best option for tear troughs and to "blend" the area you are noticing depression. Juvederm is often used in that area, but it is a bigger molecule and the results tend to vary. In person, your injector will be better able to assess which product and how much should be injected.

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Restylane and under eye treatment

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You have options for tear trough treatment - Restylane, Juvederm, Belotero, all will provide volume and injected expertly, would help restore some of that loss you are noticing.

Sam Naficy, MD, FACS
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These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.