Interested in tear trough correction and nasolabial fold fillers (Photo)

Question

I have deep set eyes with dark depressions, especially in the tear trough areas, as well as deep upper nasolabial folds. Wondering what type of filler and how many syringes in total I would need in order to fix these problems. Thanks !

Marc DuPéré, MD · Answer

Thank you Ana for your question.We are lucky in Canada and Toronto to have many wonderful fillers.  I personally perform all my injections myself and for 14 years now, as I believe I can provide the ultimate beautification and rejuvenation.  It is also safer.I work with the 2 companies that have been around since the beginning of fillers about 15-16 years ago: Juvederm and Restylane.  They have a great safety profile and they keep investing in research.Now both have come up with longer-lasting fillers: restylane has the Emervel family and the Juvederm has the V fillers: volbella, volift and voluma.  They are slightly more expensive but they last 30-50% longer.From the pictures you shared with us, I would estimate 3cc of fillers would do great.  And you can see the results right away (yet it gets better over a few days) so your injector and yourself can decide if this is enough at the time of your treatment.Tear through correction is not the the beginner injector.  Best to seek a plastic surgeon who does all his injections as the knowledge of the anatomy is crucial.  And it is your face.Let us know if this information was
useful.

Best regards,

Dr. Marc DuPéré, Toronto aesthetic
plastic surgeon and body surgeon

Asif Pirani, MD, FRCS(C) · Answer

You would need an in-person consultation to determine the answers to your request. Having said that, I wouldn't be surprised if you needed 1-2 syringes of filler depending on the consultation findings. Hyaluronic fillers like those from Restylane and Juvederm are the most common fillers used. I'd recommend Restylane for most people.The foregoing information provided is not intended nor implied to be a substitute for professional medical advice, it is provided for educational purposes only. You assume full responsibility for how you choose to use this information. Always seek the advice of your physician or other qualified healthcare provider before starting any new treatment or discontinuing an existing treatment. Talk with your healthcare provider about any questions you may have regarding a medical condition.

Jennifer Parker Porter, MD, FACS · Answer

I typically recommend Restylane or Belotero for the tear trough area. They are both hyaluronic acid fillers. Both can be used in the nasolabial folds as well. Typically patients need only one syringe for the tear trough. The actual amount should be determined when you are examined by your doctor.

Martin Jugenburg, MD · Answer

To address tear trough any soft filler will do.  Hyaluronic acid based fillers (juvederm, teosyal, restylane) can all do the job.  How much is required depends on an in-person consultation.  Each person is different.  And it's always better to underfill than overfill, because you can always come back for more.  Correcting an overfill is more difficult.For the nasolabial folds most fillers are acceptable, however based on your pictures I am not sure if I would recommend anything.  You don't seem like you need fillers in that area.  Obliterating the nasolabial fold completely will lead to a flat face look

Steven Wallach, MD · Answer

I prefer to use restylane diluted for the lower eyelid tear trough region. The folds can be treated with many different forms of HA's.

Edwin Ishoo, MD · Answer

By enlarge any HA filler will do the trick. Its more about finding a skilled doctor to do your treatment than the filler. Once you choose a doctor, that doctor will choose the treatment and what they like and their personal experience with the product.

R. Stephen Mulholland, MD (retired) · Answer

Dear Ana_SavicRDH,

Thank you for your clinical post and photograph.  The areas that you have outlined are quite
common sources of concern.  You are quite
young and the lower lid hollowing is more of a hereditary concern.  Your nasolabial fold or smile lines do not
seem terribly deep, however, even the passive presence of these can add
somewhat to the aged appearance of the face.

For the hollowing under the eyes and the darkness usually a
combination of soft tissue fillers especially ones that do not absorb too much
water such as Restylane or Belotero are optimal.  Judicious use of this product injected deep
under the eyelid muscle to prevent bumpiness or a bluish discolouration is
important.  Here the skill of the
injector is critical.  You also appear to
have some discolouration to the skin. 
This is often due to a venous engorgement or a stasis of venous blood,
which can usually respond to a special kind of lower lid laser.  When it comes to smile lines it is important
not to try and over inject smile lines as it creates an abnormal almost simian
effect to the face.  Usually softening
the smile lines with long lasting HA gel such as Juvederm Voluma or Esthelis
Fortelis [ph] can achieve a nice result. 
Elimination of the smile lines is usually not desirable and judicious
use of soft tissue fillers is important. 
You’d also be a good candidate for micro fat grafting of the hollowing
and tear troughs as well as smile lines.

This combination of soft tissue fillers and venous
discolouration laser should give you a more rested look to your face.  I would recommend the use of microcannulas to
minimize the risk of embolic complications, skin necrosis or even
blindness.  It is important to seek out a
skilled physician who has experience in these areas and I think you can expect
an excellent result.

I hope this information has been of some assistance and best
of luck.

For more information, please review the link below.

R. Stephen Mulholland, M.D.

Certified Plastic Surgeon

Yorkville, Toronto

Robert T. Buchanan, MD (retired) · Answer

There are a number of ways to treat the tear troughs and nasolabial folds. However, the best filler for this is st way to correct both is to fill the medial malar (cheek) area under the tear trough, lifting the malar tissues. This eliminates both the tear troughs and nasolabial folds. The best filler to accomplish this is something like Juvederm Voluma. Not only does it do the job best, but it also is the longest lasting filler available (up to 2 years or more). See an experienced plastic surgeon with significant understanding of nonsurgical facial rejuvenation.

Jon A. Perlman, MD (retired) · Answer

I think that you're a good candidate for the use of fillers.  I enjoy using Juvederm Ultra XC in this area but others prefer Restylane or Belotero.  I think most important is the experience and skill of the injector.I would start with one syringe but be prepared to use a second depending upon the results you seek in your nasolabial area where most of the volume would be used.  An issue of course is your budget and availability.Good luck and enjoy your results!

Interested in tear trough correction and nasolabial fold fillers (Photo)

Answers (9)

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