Is my skin just too thin for fillers?

I'm 36 years old and am dealing with reduced volume in the tear trough area. Over the past few years, I've gotten Restylane and Juvederm fillers from three different doctors. Every time resulted in noticeable lumps that needed to be dissolved. I've also regularly received fillers for the nasolabial folds; those have worked really nicely and I plan to continue getting them. Should I take this as a sign that my undereye area is simply too thin for fillers, or is there something I'm missing?

Doctor Answers 5

Facial Filler disappointment for the Tear Troughs

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Dear jodkay:

This is common concern. Thin skin does make it tougher to hide the positive qualities of hyaluronic acid (HA) fillers but there are other issues to consider.
  • while the molecule used in HA fillers is the same, the chemical linking and cleaving of the molecules promote the individual projection, fill or spread of the product and therefore its interaction in your tissues. 
  • each injector has a wide breadth of experience, knowledge, talent and skill.
  • each injector will choose a different grouping of fillers for patient injection
  • each patient is different with less or more challenging concerns and desires. 
That said, 
  • smoother, less linked and smaller particle HA's do best in thinner dermal skin like that in the tear trough.
  • more projecting HA particles belong deep near the bone, and 
  • more volumizing fillers generally do best in the subcutaneous, subdermal and muscle layers. 

  • Such layering and choice of the proper HA product leads to the best results.
  • Each injector will have their own techniques and experience to achieve the desired result.
Choose your injector(s) wisely. There are other options to consider in facial filling, skin firming and overall anti-aging. In general, a Board Certified Plastic Surgeon, ENT Facial Surgeon or Dermatologist will have better understanding of the use of these evolving facial fillers. 

Baltimore Plastic Surgeon
4.9 out of 5 stars 103 reviews


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 I'm sorry you've had such an unfortunate experience however it could be the filler that you were using. Thinner fillers made of hyaluronic acid such as Botero might work better for you. 

Fillers Into Troughs ... Use Cannula and Do Cheeks Before Troughs

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I have a policy on how to treat this area and you would need to be evaluated in person to determine what is best.  But cannula injections will limit compliations and treating the cheeks especially the mid face prior will limit the amount of filler needed.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 207 reviews

Restylane for thin skin

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Hello Jodkay,

If you have had multiple different skilled injectors using Juvederm and Restylane in the tear trough and have developed lumps, I would recommend a softer product.  The two products that come to mind are Restylane silk or Belotero.  These are both hyaluronic acid just like Juvederm and Restylane but they have smaller particles.  This means they are less likely to be lumpy (although they won't last as long as Restylane or Juvederm) and is the reason they are approved for more superficial wrinkles.  And make sure you are receiving injections from a skilled injector to minimize the risk of lumpiness.  

I hope this helps and good luck.  

William Marshall Guy, MD
The Woodlands Facial Plastic Surgeon
5.0 out of 5 stars 31 reviews

Fillers and Tear Trough

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The tear trough area is a very delicate area and an advanced technique.  An in office consultation is needed to determine what is the best filler for you. I have very specific fillers that I used based on the patient's facial anatomy.  Best, Dr. Green

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.