How Many Syringes of Restylane for Long Tear Troughs?

The tear trough is the slight depressed area on the medial cheek, located below the lower eyelid.  One can inject small quanitites of hylarunic acid ( Restylane, Juvederm) in these areas in order to fill them out and give a less tired or aged look.

This is an area that is a skilled and experienced injection professional should be considered. It is very easy to end up with an overdone and lumpy result.  The skin is very thin in this area and one can sometimes see the pearls of material, and it often takes more than one session to obtain a good result.  I, personally, inject very small amounts along the bone - deep beneath the trough in a line to build up the depression and avoid seing/feeling the material.  You are better served having to be injected twice - than being overdone in one session.

Hi @sadcheeks. I recommend starting with 1 syringe. You would be a great candidate for tear trough
fillers. Restylane and Belotero work great. I recommend seeking treatments from expert injectors who have the skill and experience to precisely inject fillers into treatment areas and avoid risks and complications. Best of luck, Dr. Nima!

The number of syringes of Restylane or Jeuvederm is highly dependent on the exam and appearace you wish for. For that reason we typically do a significant correction the first visit then "fine tune" afterwards.

Patients especially on their first time may require less than 1cc of Restylane for both sides, so 1/2 cc per side.  You can always add more if you need it.  I like to err on the side of less product to obtain the most natural result possible.  I would consult in person with an Oculoplastic Surgeon or a physician with extensive experience with the delicate and complex anatomy under the eyes.

Typically in younger patients that do not have deep tear troughs, 0.25 cc's per side is sufficient, for a total of 0.5cc. Some patients that are extremely deficient my require one to even two cc's. If there is product left over you can use it over the lateral cheeks to accentuate them. Under the eyes, Restylane lasts longer then in the lips and nasolabial folds, up to one to two years.

Restylane under the eyes is better than Juvederm, as it does not absorb as much water and therefore you will not look as puffy right after injection. Also, if you are not pleased with the result you can use hyaluronidase to remove the product. I have however, never had to use hyaluronidase with my injection technique.

Radiesse should be avoided in the tear trough area as any resultant nodulairty is difficult to treat in this area. Radiesse however is an excellent volumizer for the cheeks and mid face.

 

Hello sadcheeks.  Based on your pictures, we may actually recommend two different fillers for you.  The darker areas immediately under the eye, we do categorize as a tear trough issue and would most likely use a .4cc Restylane syringe to address this issue.  This would be the total estimate including both sides.

As the line move3s further away from the eye, we see what's called a "malar separation".  This means that the muscle in this area has moved downward and is creating a depression where it is pulling away from the upper cheek.  In this area, we would very likely use a 1.5 cc Syringe of Radiesse for fill and support.  This would be the total estimate including both sides.

See the pictures below for a patient that had a similar problem.

Start conservatively with one syringe and balance both sides as  the areas are being filled rather than starting with one syringe on one side. In this way you may be able to get by with one syringe.

I inject a great deal of tear troughs and generally it takes a syringe of Restylane or Belotero to fill in this area. It will take at least one additional syringe to treat your nasolabial folds or mouth area. For the best cosmetic results please consult a dermatologist who is experienced with facial injections. 

While in person consultation would be important to verify, a 0.5 cc or 1.0 cc syringe should be sufficient for tear throughs.  1 to 2 syringes of 1.0 cc Juvederm or 1 syringe of 1.5 cc radiese should be sufficient for the lower face.  

very little is needed for that area, but consider Sculptra for the more lateral extension of the trough which is actually cheek descent. good luck