Are my tear troughs over or under filled?

Question

I recently got filler to correct my tear trough lines. Over 2 weeks later, things are not smooth or even, particularly on one side of my face. Two syringes of juvederm vollure were used (one on each side). I was wondering what would be the best thing to do to correct this.

John J. Martin, Jr., MD · Answer

Need to see a pre picture to see what you looked like before any filler.  There is still some shadow in the tear trough area, but this may be much better than the pre and you may be ok with this.  You do have some edema down in the malar fat pad area, especially on the right side.  The vycross products such as Vollure may cause some edema that can last a while.

Brandon Richland, MD · Answer

Hello, and thank you for your question. It is hard to determine if you were under filled or over filled without seeing before/after pictures side by side. Tear trough filler can sometimes settle differently depending on one’s anatomy and placement of filler. I usually recommend starting with cheek filler and then adding tear trough filler, as the transition can appear more smooth in the lid-cheek junction. You could always follow-up with the same provider or a different one, and determine if you should dissolve the filler, or if additional filler may be needed elsewhere to help balance.

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.

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs.  It is difficult to render an opinion without before images but remember if you do not like the appearance you can have the product dissolved.  Based on the limited pictures it appears that correction of your medial cheek should have been performed first, followed in a second stage by undereye filler.  Hope this helps.

Mohammed F. Ahmad, MD · Answer

Hello. Thank you for your question. I don't think your under eyes are over or under filled. You need to build up your mid face (cheeks) in addition to adding filler under your eyes.

Vibha Gambhir, MD · Answer

Hello and thank you for your question.  It is hard to tell without seeing before photos or seeing you in person.  Looking at your photos, you can use more filler in the under eye.  We typically use volbella which is a hyaluronic acid filler, very thin and soft perfect for under eyes.  Under eyes are very delicate and must be done slowly to make sure not to over fill or create "bumps".  Voluma which is a thicker HA filler, can be used in cheeks and jawline, would compliment the volbella nicely.  Typically under eyes and cheeks are done in combination, but done slowly.  Hope this helps!

Darryl J. Blinski, MD · Answer

Sometimes difficult tear trough deformities need a few sessions to obtain best results. Appears you need additional injections of very little. I might try VolBella instead.

Are my tear troughs over or under filled?

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