Are my tear troughs still over filled or was the placement wrong? (photos)

Question

I had perlane injected in my tear troughs one month ago. I swelled horribly but eventually the swelling subsided. Since then I have had a thin "ridge" of what looks like product under my eyes. Underneath the ridge is a very dark line. I have had 3 rounds of hyaluronidase injected to get rid of the perlane but my doctor is doing it slowly. I actually look older since this has all been done. I now have a deep line between the ridge and my eyes. Was it just over injected or is the placement wrong?

Jason Emer, MD · Answer

For unique cases where a variety of modalities could be used to treat the condition, I would suggest an in-person or virtual consultation to develop a custom and effective treatment plan.  It is difficult to precisely define the best option without collecting the same information. I suggest reaching out to an expert for a consultation with surgical and non-surgical methods to get a comprehensive option. Best, Dr. Emer.

Michael H. Gold, MD · Answer

Thanks for your
question and sorry that you are having problems post injections.  You need to work with your injector to make
sure that you are receiving the most appropriate post-treatment to minimize
this over-correction that you received. 
You need to make sure that your injector works with a board certified
dermatologist or plastic surgeon to make sure that the optimal products are
used in the most appropriate places.  For
the tear trough area, most of would use Restylane or Belotero, and then Juvederm.  Perlane is a little “thicker” and probably
explains the swelling you are having now. 
Using hyaluronidase is most appropriate, but we need to make the Perlane
in this area go away and things should go back to normal. Then, with the right
injector, and the right product, this area can be taken care of so that things
look great.

Susan Van Dyke, MD · Answer

Overfilling of the delicate tear trough can certainly happen with a robust product like Perlane.  Happily hyaluronidase is very effective in reversing the problem as it seems in your case.   The question of whether there is still product in the region is best answered by reviewing and comparing before treatment photos and after treatment photos.  Once baseline is established then a reevaluation of your goals and the methods available to reach your goals is in order.  If the goal is to look less tired then volume in the mid cheek and cheekbone (to give some lift) may be the best approach rather than direct injection into the tear trough.Working with filler to enhance the appearance is a lot like sculpting.  A little bit in the right place may be better than a lot in the wrong area.  The problem can be that it takes a very experienced eye to determine the "right" area for the desired outcome.

Are my tear troughs still over filled or was the placement wrong? (photos)

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