What should I do first, tear trough or cheek fillers? (Photo)

It's hard to give you complete recommendations without examining you in person and with the limited photo.  But I generally recommend starting treatment in the areas of the face that are most hollow or with the greatest loss of natural volume.  These are the areas that make us look most tired or older.  Then over time I would expand the areas of injection to the rest of the face.  In your case, the areas under the eyes are relatively hollow so that seems like a reasonable place to start.  after a careful examination, your doctor can decide which product is ideal and whether other areas need injection.

I like to treat the cheeks first, see what effect it has on the tear troughs and then inject the tear troughs if necessary, perhaps with a different filler.  Both areas can be treated at the same visit. Which filler to use is not as important as having treatment with an experienced physician injector who will use their favorite products.

I would do both if your budget would allow it. I dont know how old you are, and dont have a side view.If you are middle aged and lost cheek fullness on the side view the combination of Juvederm in the tear trough and Voluma in the cheek would camouflage this the best. A younger patient just Juvederm, Boletero or Restylane in the tear trough would improve.Several years ago, just treating the tear trough alone was what we did, but not helping the upper cheek with another filler is more common.Another option is transbleph surgery and moving the fat across the trough. The appearance is caused the muscle attachment to the orbit.A consultation is necessary to make the final recommendations whether to do one or both

I routinely do the cheek fillers first and depending on the result tear trough fillers may or may not be required.The cheek filler fills and lifts and makes the tear trough less prominent, that in turn will lead to less of filler required to correct the tear trough.All the best

If your tear trough is your main concern, then that is likely the best place to start. Good luck with your decision to move forward.

Dear Jarong,Think of the goal and look you are striving for when posing your questions.  Do you want to look like a refreshed version of yourself or someone else altogether(!)?  With the camera lighting of just the single view of your face,  I can see that there is a suggestion of a tear trough shadow but overall, you have a youthful appearance. If there is a persistent shadow below one or both of your eyes that makes you look tired when you're not tired, then a tear trough filler will address that concern.  However, it seems like it is going to make a subtle difference on your left side and the right side looks fine without filler.  Your cheeks also do not looked aged, wrinkled, or in "need" of volume restoration- just my opinion from your photograph.  Its best to have an experienced plastic surgeon sit with you face to face and let him or her advise you what can be done if anything to achieve your goals. All the best, Dr. Lach

Dear jarong,

Thank you for your clinical post and photograph. From the photograph provided it does appear
that you have significant loss of volume or hereditary lack of volume under
your eyes. This infraorbital area or lower
lid area should be injected first as occasionally and especially in patients
who are young it is important to see the effect of one soft tissue filler on
other dynamic and static parts of the face.

Generally, once you’ve assessed the value and the effect of
soft tissue fillers on the nasojugal groove or infraorbital groove then
addition cheek fillers done subtly can also enhance the appearance of a
youthful fresh appearing facial contour.

I have been performing facial volume lifting for over a
decade and generally use a microcannula to secure the safest possible
restoration or contour and shape where there was none.

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

The middle of the face is typically less "full" in Asians.filler in the cheek and tear trough will make a nice change.Find an experienced plastic surgeon/injector and do both.Look at photos and make an informed decision.

I strongly suggest that you do all re-contouring at the same time. The two areas are intimately connected and should both be improved at the same time.