Permanent Filler for Tear Troughs?

Rejuvenation of the under eye area is different for different ages and degrees of problem. As surgeons, we must be concerned not only giving a nice durable result to the patient, but also to preventing problems which can be long-lasting and in some cases untreatable.
The lower eyelids are particularly dangerous because of the thin skin which shows all bulges clearly. Remember that when you see the fat that normally bulges out below the lower eyes, this fat is covered by the skin, by the orbicularis muscle and by the orbital septum, yet it appears at the surface. This guides our philosophy that things we do should not be unnecessarily irreversible.
For younger patients, Juvederm, Perlane or Restylane work very well and are generally smooth. Obviously your doctor should be familiar with the anatomy and know where larger vessels are typically located, especially as they supply the central midface, to avoid unnecessary bruising.
Permanent and semipermanent fillers in the tear trough area are risky because they can develop granulomas (permanent lumps) which may require excision. Sculptra around the eyes is particularly bad in this respect. Silicone is also a disaster, with chronic permanent, untreatable swelling. I have never seen granulomas from Juvederm. Occasionally, patients have prolonged swelling from hyaluronic acid fillers, but I have never seen permanent swelling. Although it is almost never necessary, hyaluronic acid fillers can be reversed with hyaluronidase, not true for the other semi-permanent fillers.
For more severe problems of aging, lower eyelid surgery becomes an option. This could be transconjunctival surgery, fat repositioning surgery, and possibly canthal surgery , depending on the appearance of the eye and any necessary adjustments.
For patients who have had previous eyelid surgery and have noticed a rounding of their eyes with pulling down of portions of the lower eyelid, a cheeklift may be necessary. Cheeklifts (i.e. LUSIC) can elevate the thicker tissue of the midface, concealing hollowness.
We have been quite satisfied with LiveFill (nontraumatized fascial fat grafts) and have presented and published our results. We have found by cellular studies that LiveFill is alive when the grafts are sculpted from the patient's own tissues, unlike fat injection, where most of the injected cells are dead. While the fat injection technique, under competent hands, can yield excellent results, even in the very best of hands there are often irregularities below the eyelids that can be difficult or impossible to fix.
So there is the strategy for lower eyelid hollowness through the years.
Patients who focus on the filling material rather than the person administering the material or performing the procedure will be disappointed; all painters use paint, but their art is not equal.

I would not recommend Radiesse to be injected into the tear trough area since it is not reversible. Typically, HA based fillers like Juvederm or Restylane are injected into the tear trough area and are reversible with Hylenex if need be.

Thank you for your question in regards to tear troughs. Fillers can be a wonderful product for treating the tear trough area. We use both Vollure and Voluma for tear trough correction. For very deep grooves you might need the lifting capacity of Voluma, but for less severe volume loss Vollure is wonderful. These two products tend to have the least amount of swelling compared to the other hyaluronic acid fillers available in the US, which is very desirable in this specific treatment area. We do not recommend using permanent fillers in the tear trough area. To find out what is best for you, see two or more board-certified providers in your area for a complete evaluation to make sure you are a good candidate and that it is safe for you to have treatment. I hope this helps.

Patients are often interested in long term solutions for
their aesthetic concerns. When patients have tear trough deformities they often
request long acting fillers for this reason. Unfortunately, long acting fillers
aren’t always the best choice when treating this type of problem. Radiesse,
Scultptra and artefill are all associated with the development of granulomas,
nodules and skin discoloration. This is especially true when injections are
performed in the lower eyelids where the skin is very thin. In addition, these
fillers aren’t easily reversed and therefore effectively permanent.For
this reason, we prefer hyaluronic acid fillers for tear trough deformities.
These fillers which include Juvederm, Restylane and Perlane are soft and smooth
and can be easily reversed with the enzyme hyaluronidase when patients are
dissatisfied. In patients who are satisfied with this approach, but still
desire a long term solution, autologous fat injection may be appropriate. It’s
important to understand that lower eyelid filler injections can be very
effective for treating tear trough deformities. Unfortunately long acting
fillers may be associated with complications and aren’t easily reversed. For
this reason it’s important that patients with tear trough deformities be
evaluated by a board certified plastic surgeon. This surgeon should be able to
formulate an appropriate treatment plan for this problem.

First, Artefil is the only permanent filler FDA approved in the USA. That being said, none of the fillers are FDA approved in this area. The tear trough area can be one of the trickiest and unforgiving areas to use fillers.
With that in mind, I do not recommend Artefil for this area. Radiesse is a good option, but not necessarily the best. Radiesse, if injected improperly, cannot be removed (except surgically, same with Artefil).
If a hyaluronic acid based filler, like Restylane or Juvederm, is used, and you don't like the results, it can be removed easily by injecting a medication (Vitrase) that dissolves the product completely.
Results with these 2 fillers in the tear trough area can last 9 months to well over 1 year. Make sure you do your research and seek out a very experienced injector.
Best Wishes,
Dr.Groff