Restylane and Juvederm not working for tear trough?

I would have to see photos, but generally one syringe of filler is enough for the vast majority of patients.  However, if the problem is not the depth of the trough, but the height of the fatty pads or bulging beneath the eye then you may need a surgical approach to remove the fatty pads.  If you think of the tear trough area as a mountain (the fatty pads), a valley (the tear trough) and a mountain on the opposite side (the midfacial cheek complex), then you can either fill in the valley with filler or take down the mountain with surgery.  It really depends on what is causing the look.  I hope that information helps.

you likely need more filler to this area or fat grafting.  I would avoid any other permanent fillers to this area.  Best, Dr. Emer.

Thank you for posting your question. Without photos, it is not possible to know the specifics of the problems. You would be best served by seeing an experienced, board-certified Oculoplastic Surgeon in person for comprehensive evaluation and discussion of treatment options.Good luck,

The lower eyelids can look bad because of herniated fat pads and hollow areas or both.  Hyperpigmentation,, dark veins, periocular muscle movement, lid laxity and wrinkles are also a concern.  It is important to see a specialist who  understands all of these issues.   Fillers only address the hollowness, but must be placed properly.