Can you treat tear troughs by filling the cheek area? (photo)

Question

I am 41 years old. I recently lost weight and as a result my chubby full face disappeared. The tear troughs which are hereditary also became more noticable. I had Restylane injected under my eye and around my nose a little over a week ago, but I can tell it has not made much of a difference. The ridge is still there. I am wondering if I should have filler in my cheek to create a more smoother appearance from eye to cheek. Any advice would be greatly appreciated.

Nima Shemirani, MD · Answer

Hi @GinaSM! The upper cheek is a major support for the under eyes. So when there is volume loss there, not only do the cheeks reflect this, but the under eye can as well with the development of tear trough and under eye hollows. Addressing the volume deficit in the cheeks with the use of a volumizing hyaluronic acid filler would be a reasonable place to begin. Best of luck, Dr. Nima!

Jason Emer, MD · Answer

I always tell my patients to do "cheeks before troughs" so that you do not get the puffy abnormal under eye look.  Often ill do the cheeks and a very small amount in the trough and see the patients back in 2-4 weeks and do a little more then under the eyes.  Please see an expert.  Best, Dr. Emer.

Michael A. Zadeh, MD, FACS · Answer

Good question Gina. Unfortunately, your picture doesn't show so I can only speak in general terms. Restoring volume in the cheeks with fillers will help the appearance of the tear troughs. However, most people with a lot of volume loss in the tear troughs will still need filler there. The best is a combination of the two. Chances are, you may still end up needing some more filler to your tear troughs after volume correction of your cheeks. Hope this helps!

James R. Gordon, MD, FACS, FAAO · Answer

Thank you for asking your question. Most patients who require tear troughs to be filled also need their cheeks to be enhanced with filler as well. The overall appearance is typically much nicer than with only tear trough treatment. Good luck.

Steven Swengel, MD · Answer

Thanks for your good questions, though the photo as posted does not render so I can't comment on your specific condition. It is difficult to see anything when it downloads to my computer.In general, often the best approach to improving tear troughs and mid face deficits is to first address cheek volume and then, if it is still there, to address deepening tear troughs, or even dark circles under the eyes. Sometimes, getting cheeks back into place is enough to resolve some minor tear trough deficits.Once cheeks are re-established, I then like to go in with Restylane (or Belotero) and address specifically the area around the eyes. The best end result is when a smooth transition from  lower lids to cheek is established so that the juncture is smooth, natural, and doesn't catch light that comes downward from above.An in person consult with a board certified derm or plastic would be your best approach at this point.Dr. S

Melvin Elson, MD · Answer

It is not possible to tell what you need as there is no photo here.  to smooth out the ridge you are referring to you could get some filler above the ridge to smooth it but again without a picture it is not possible to tell