Tear Trough Fillers - What is the best technique?

Question

I've been thinking about getting tear trough fillers, but my question is about technique as everyone does it different. I went to two doctors who perform the procedure differently. One releases the filler over orbital bone and the other releases it into the hollow. These are two very different techniques and I want to know which renders the best result.

Nima Shemirani, MD · Answer

Hi @928Medina! Most facial filler products that are injected into this area should ideally be placed in the tissue plane directly on top of the bone, or at least underneath the eyelid muscle layer. If a facial filler product is placed too superficial in the skin, or on top of the muscle layer, the product may settle in with an abnormal appearance and can look to be lumpy, swollen, or irregular. Best of luck to you!

Jason Emer, MD · Answer

Fillers like Belotero, Volbella, and Restylane Silk are good for improving under the eyes, but keep in mind that a combination approach will give the most improvement. My patients try to get non-surgical treatments to avoid surgery, so we use fillers, lasers, microneedling/PRP and stem cells. I suggest consulting with an expert to develop a treatment plan best suited for you. Best, Dr. Emer

David S. Balle, MD · Answer

Filling the tear trough requires a highly skilled experienced core physician. Every patient is unique and the needs are often different. I commonly use a cannula to deliver the filler to the needed area most typically on the bone. Sometimes this is followed by small aliquots in other planes to achieve the best result in an individual with either a cannula or needle.

Vibha Gambhir, MD · Answer

Hello and thank you for your question.  The injection technique, filler used and where the filler is injected is very much dependent on the patients need and injector preference.  Volbella is a very thin filler that is placed in the hollow, where a tear would fall.  This will decrease shadowing/darkness under the eye.  Voluma,  which is a very thick filler, is then placed over the bone to support the undereye and contour the cheekbone.  Every patient is different, different techniques are used, different fillers are selected and placed according to the patient need.  In the end, if desired results are achieved, the patient will be satisfied and happy.  Be sure your injector has experience, is board certified and does a full consultation to understand your goal.  Hope this helps!

Chase Lay MD and Associates - San Jose · Answer

Hello,
Thank you for your question. Technique used really depends on patient anatomy and material of filler used. Both are right in their own respective ways. Filler placed deeply over the orbital bone will give it a lifting effect and correct some hollowing.  Sometimes we will use a cannula to safely target the hollow area also.
Best,
Kathy Luong, RN

Mehdi Sina, MD · Answer

Hi,There is no one correct way to perform injections with fillers. The best injectors will use different techniques depending on the patient's specific anatomy and needs.Best,

Robert T. Buchanan, MD (retired) · Answer

Very good question. Injection directly into the hollow above the orbital ligament is what was done when the only fillers we had were light. Unfortunately, there were a larger number of problems, especially swelling. This still happens and I see examples of this all the time on this site. A few of us began using Radiesse, a much heavier filler, and injecting it on the bone below the orbital ligament, pushing the tissues up and correcting the problem by correcting what caused it. Initially, everyone doing the other technique told me I was doing it wrong. However, I got great results with almost no problems. When Allergan introduced Voluma, a heavy filler, they sent a physician around demonstrating the method of placing the filler on the bone. Unfortunately. physicians are set in their ways and slow to adopt new, better ways. It appears that you have found someone who understands the anatomy and presentation of the problem and how to best deal with it. Do not let anyone "inject the hollow."

Tear Trough Fillers - What is the best technique?

Answers (7)

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