Which filler is best for tear troughs? (Photo)

Question

Im at my mid 30s. There is not much fat under my eyes. I am thinking to have a filler to correct my tear troughs and dark circles. Which filler (Restylane or Juvederm) would work best for my case? How much injection do I need? What happens after the filler is gone? Would I have excess skin after because it has been pumped up for months? I also have concerns about the safety since the the injections are very close to the eyes. Thanks for answering my questions!

Jeff Angobaldo, MD · Answer

Thank you for your question. Most patients will be treated with 1 syringe of restylene or juvaderm ultra for both eyes. You will not have excess skin after the product resorbs.  Their always risks with any procedure. Make sure you go to an expert with much experience in tear trough injections.  Best wishes.

David J. Myers, MD · Answer

For the under eye area I prefer to use Restylane or Belotero, though is does depend on the facial structure. Juvederm tends to cause swelling under the eye due to the skin’s thinness (diluted Juvederm can work well in this area though if placed a little deeper).  I usually use between .5 to 1.0 syringe of Restylane when dealing with the dark circles under the eyes. The filler slowly dissolves as time goes on.  Injected properly, the filler will not dramatically disappear or cause swelling, though this can occasionally still occur.  Fortunately there is an eraser, hyaluronidase in those rare cases.Restylane and Belotero are both safe due to their composition of hyaluronic acid that is produced naturally from the human body. The synthetic and biodegradable hyaluronic acid that forms Restylane® and Perlane® has already been used in Canada and Europe for many years. These products contains the same 20 mg/cc intensity of hyaluronic acid, but they vary in the sizes of packaging in gel forms. The variation in their properties allows customization of injections depending on each specific patient’s facial folds, wrinkles, and lip enhancements. See a board certified dermatologist or plastic surgeon for best results with your injections.

Sam Naficy, MD, FACS · Answer

My favorite fillers to utilize in the tear trough are are Restylane and Belotero depending on the anatomical landscape. In my opinion Juvederm has the tendency to swell and be less forgiving, sometimes resulting in malar festoons or water bags under the eyes.

Soheila Rostami, MD, FAAO, FAACS · Answer

Try to have  Restylane first and I believe you would need 2 ml of Restylnae, and then you can add Voluma if you need to add some to the check area. I believe the best thing for you is the combination treatment. You need some injection in the lower part of the check as well below the lower eyelids.

Monika Soni, MD · Answer

Thank you for your question. Restylane is the best filler to for tear trough because it is thinner compared to Juvederm which is more likely to cause consistent swelling and bruising.Moreover, there is less discomfort, less recovery, and there is optimal results using blunt cannulas. On top of this, the treatment is much safer with little risk of vascular or visual changes. Hope this helps.

Manjula Jegasothy, MD · Answer

Belotero®, Restylane® and Restylane Silk® are considered the current gold standard fillers for treating the tear troughs. Since this is an advanced technique, please consult a board certified aesthetic dermatologist for a consultation.

Steven Wallach, MD · Answer

I prefer to use a dilute restylane mixed with lidocaine to allow the restylane to flow more easily, and be more malleable.

Henry Gasiorowski, MD · Answer

There are many hyaluronic acid derivatives that may be used to inject the tear troughs and technique is of utmost importance. Injections must be deep otherwise the substance can obstruct the lymphatic flow at the junction of the very thin skin of the eyelid and the thick skin of the cheek resulting in large watery bags under the eyes. Also, the correction must be performed in stages for the same reason. I have found Restylan Silk to be an ideal substance for this purpose. Its longevity varies person to person but we can expect one to two years depending upon how quickly the patient metabolizes the product. Once the filler is gone you will look slightly better than when you started because your own cells will grow into the product leaving you with a bit more fullness than before you started. H C Gasiorowski MD

Jo Herzog, MD · Answer

I disagree with Dr. Kim's not wanting to ever inject tear troughs as many people do have tear troughs that are hollow and will benefit from some Restylane or Belotero. However, although I can not see your whole face, I get the impression that you might benefit more from augmenting your cheeks before doing anything to your tear troughs. You are more flat than you are hollow. Some good filling of the cheeks might be what will suit you best.

Tae Ho Kim, MD · Answer

It seems to me that a lot of doctors like to inject in the tear trough.  However, I think this is a bad idea.  Why? First, the accentuation of the tear trough is either increasing fullness of the lower eyelid from bulging periorbital fat or loss of cheek volume or both.  It is not like the tear trough area sinks abnormally and the anatomy of the lower eyelid or the cheek remain normal.  This is an area of dynamic relationships and it is important understand this.  Unfortunately, many doctors don't.  Otherwise, they wouldn't inject this area so willingly and fail to see how swollen or bumpy people look afterwards.  I would advise you to get evaluated by a board certified plastic surgeon and get an expert opinion on your facial anatomy and recommendations on what would be best (hopefully not tear trough injection).  The picture you show is limited and therefore I can't tell you whether or not you need improved volume to your cheeks.  It seems like you would.  The only filler I like to improve volume to the cheeks is Sculptra, not hyaluronic acids.  Do your homework as best as you can.  Good luck!

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