Restylane for Tear Trough - Uneven Results

Hello. Injected about 2 months ago. Left side shows markedly less results. When I went for follow up the Dr. tried to push Radiesse injection for cheeks in addition to doing the Restylane. Shouldn't he have fixed the uneven results first? I am 37. I am happy with the right side but unsure what to do about the left...will there be a charge again to make both sides even? Should I try another Dr?

Doctor Answers 11

Tear Trough Uniqueness

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It is not unusual to require a follow up for finessing the  results of eye trough injections. Ordinarily, small increments are best injected and often this area has mild to moderate swelling . Swelling  can distort the symmetry at the time of treatment.  Most everyone, however, has a degree of facial asymmetry to begin with so correcting the obvious difference is easier to do as the swelling subsides in 7-10 days.

San Juan Capistrano Physician

Asymmetry in tear trough after Restylane injection

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I always encourage my patients to return a couple of weeks after a filler treatment, especially if they were treated in the tear trough. Every now and then, a patient needs a touch up. This is an area that you definitely do not want to over-fill, so most injectors (including myself) will be more conservative in this area. I would definitely ask your surgeon for a touch-up prior to any treatment with Radiesse.

Ryan Greene, MD, PhD
Fort Lauderdale Facial Plastic Surgeon
5.0 out of 5 stars 85 reviews

Fillers for tear trough area (lower eyelid)

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Various fillers can be used to fill in the lower eyelid or tear trough area (restylane, juvederm,fat).  This area should be approached conservatively, as it is always easier to go back and add more filler than to remove excess product.  After the initial injection is done, it's common for patients to need a touch up in certain areas, which is typically done a few weeks later.  Each office varies on their policy, but most will only charge you for more product if it's needed, not for the actual injection itself. Discuss this with your physician/injector prior to the initial treatment.

Radiesse is a filler which can be used in the cheek area, but should not be used directly under the eye, in the thin eyelid skin region.

Best wishes,

Dr. Bruno

William Bruno, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 410 reviews

Restylane works for tear trough.

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1)  Asymmetry should be corrected before other procedures.

2)  For touch ups, we only charge for the actual cost of the material.

3)  If your confidence is shaken, go elsewhere.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

You have some uneven results,but how much has it improved?

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We do not have your before pictures to comment about the degree of the asymmetry. your right side needs a little more over the cheek(you stated that right is perfect). The best picture for evaluating the tear trough is pictures with no flash and no facial animation.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.7 out of 5 stars 152 reviews

Fillers in tear trough

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Everyone has asymmetry.  One side may have needed more filler than the other.  It is hard to see in the photo.  You can always add more filler to the side that you feel is a bit underfilled.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Fillers for facial hollowing

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When I first treat someone with a filler, I typically ask that they return about 2 weeks after the treatment so we can assess the initial results and decide if we are done or if we need a touch-up.  It's not unusual to need a bit more filler added, particulary under the eyes. It's much better to UNDER-correct and do a touchup than th OVER-correct. 

I think you would benefit from some additional filler under your left eye and in your cheeks (the areas are confluent and it makes sense to do a full correction of the whole area--better overall result).  It may be that your doctor was trying to get as much mileage as possible from just one syringe (patients often request only 1 syringe and don't want to pay for more initially).  You should expect to pay for your additional filler product.

Carmen Kavali, MD
Atlanta Plastic Surgeon
4.6 out of 5 stars 46 reviews

Even Cheeks After Restylane Injections

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Hi Beachgirl,

It appears that you can even out your asymmetry with the addition of filler in your left cheek area.  Our policy is to charge patients our cost for the additional material.  Other practices have different policies. You should be completely confident in your injecting physician.  I always advise to choose your injecting physician most carefully.  Good luck and be well.

Dr. P

Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 39 reviews

Fillers for tear trough

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Thank you for submitting the photograph, but unfortunately the two dimensionality of the photo and the overexposure makes it difficult to see the difference. You need to be examined from all angles and the area should be palpated (felt) on examination by the doctor who is treating you to determine if filler is appropriate and which filler is best for you.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 39 reviews

Asymmetry after filler injections-what to do?

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Asymmetry can occur after any filler injection.  I find that many patients take notice of asymmetries in their face after a filler injection, only to find out that the asymmetry was present before the filler injection when we review their pre-injection photographs.  These small imperfections are often much more prominent to the patient than to everyone else around them. It is important to remember that these asymmetries can be addressed and often improved, but perfect symmetry is usually not possible.

The tear trough is a sensitive area, and it is much preferable to under-inject and have a touch up if necessary.  I always recommend my filler patients return 2 weeks post procedure to evaluate our results and make sure everything looks the way that it should.

In your case, I would probably want to address the asymmetry in the tear trough before I augmented the cheeks.  There may be a charge for the touch up, you will have to ask your doctor about that.

Michael Bowman, MD
Roanoke Facial Plastic Surgeon

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.