Which filler is best for the treatment of under eye tear troughs?

There are no FDA approved fillers for under the eye. Most fillers only have FDA approval for Naso Labial Folds. At this date there is only one FDA approved filler for lips (Restylane).

Risking long term or permanent fillers under the eye is not worth the potential negative results. Restylane injected properly under the eye typically lasts longer than it does in other areas, so you'll likely see the volume you are enjoying longer than you might think.

Fillers have been used for many years in "off label" application.The "off label" use of fillers is chosen independently by each physician. Off label is not illegal and in most cases not dangerous. It simply means the filler is being used in a way or in an area of the face that was not included in the FDA clinical studies.

Most U.S. physicians who treat under eye hollows with fillers will generally choose Restylane or Juvederm. Both fillers consist of hyaluronic acid gel which is a degradable product most closely resembling natural skin tissue. 

Careful injection of these hyaluronic gels at the proper depths and within the anatomical safety boundaries generally gets good results.The nice "fail safe" of HA gels is that they can be dissolved quite easily if the patient is not happy with the results.

There are fillers which are "contraindicated" in certain areas - meaning they are known to create a problem or are suspected to be capable of creating a problem.

Because the tear trough is such a sensitive area, and the skin is thinnest there, any "lumping" will show. It is also a highly reactionary area and more easily bruises or swells.

Injector techiqiue and precise knowldege of eye area anatomy is extremely important. Pick experience over price promotions - particularly for eye area injections.

It sounds that you are happy with your Restylane. If you were my patient I would encourage you to accept the temporary nature and appreciate the safeguards that come with it.

Hi there! Juvederm and Restylane work very well with the tear trough area. I recommend seeking treatments from expert injectors who have the skill and experience to precisely inject fillers into treatment areas and avoid risks and complications.

Tear troughs have been injected for several years without FDA approval so there is not enough data to give a scientific answer. However, doctors who have been doing it for many years have preferences based on characteristics of the fillers. In general a less hydrophilic filler is preferred to reduce for more accurate results and to reduce post procedure swelling. Hyaluronic acid fillers are dissolvable in case of complications or undesirable results. Other considerations are the depth of placement and the use of a canal or needle. MRI results have shown fillers to last for many years in this area so accurate placement and quantity is very important to avoid having to dissolve the filler. Many doctors prefer Restylane- L for this area based on its properties.

Thank you for your question. I almost always use Belotero in that area. The reason is that other hyaluronic acid filers (Juvéderm, Restylane, Voluma etc) can leave a blue discoloration when placed close to the skin or underneath thin skin (ex: under eyes). This is called the Tyndall effect and is not desirable. In my experience, Belotero does not cause this blue discoloration. Additionally being a lighter molecular weight filler, Belotero is less likely to leave lumps or bumps under the thin under eye skin. This is general advice, please discuss with your expert injector before proceeding.

The tear troughs are a very delicate area of the face. When choosing a filler to correct the volume line in this area, we have to take into account the degree of volume line and the quality of the skin. I prefer to use a hyaluronic acid, such as Belotero, to correct this area.

Thank you for your question! I always recommend Restylane Silk or Belotero when injecting in the tears troughs as the area is very delicate and the use of a thinner filler is best. I recommend you visit a trained and experienced provider as injecting in the tear trough is a more advanced procedure.

The under-eye area is the most sensitive of all facial areas in regard to filler. For this reason, it is important to note that not all patients are candidates for filler in this area. Patients with thin, pale skin are likely better suited with another modality, as the product can show through the skin and appear a bluish-grey color, known as the Tyndall effect. For most other patients, however, a hyaluronic-acid filler can very successfully fill the depressions of the tear troughs.  

Tear toughs are one of the most delicate areas of the face and require care and expertise for a beautiful result.  When assessing  tear troughs, attention to anatomy, skin condition, pigment, blood vessels, bony structure and volume is necessary.  Addressing skin with laser or RF technology, vessels and pigment with laser and appropriate correction of mid-face volume with filler is the first step to restoring a natural look to the face and tear trough.  After attention to these items, Restylane Refyne injection with a blunt tip cannula has yielded natural, predictable results for volume restoration in the tear toughs.  Always seek out a board certified plastic surgeon for assessment and treatment of this region.

It's not the filler per say, it's your injector.  Choose an injector that does a lot of under eye filler.   I get great results with regular Restylane which is my go to for this area.  I will also use Vobella under the eye and have seen other injectors use Beletero.   Many times the under eye can be corrected by treating the mid face with Voluma.   Best of luck to you! 

I have used many different fillers for the lower lids/tear troughs. My preferred product is Restylane Refyne. I typically use a micro droplet technique with 0.15-0.3cc per side. This has resulted in excellent results for me without excessive puffiness. When I used to use Juvederm products in this area, I found they absorbed more water and had a higher tendency to create a puffy lower lid than Restylane products.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.

The most important decision in placing filler under the eyes is the injector, not the material used. There are a number of great fillers that have been applied under the eyes but I think it is best to start with hyaluronic acids like Restylane since they can be reversed. We also use Volbella in our practice since it is very easily malleable to the contours of your under eye area. I like to use fat as a long term filler since it is your own tissue, it is natural, and can help with the pigmentation issues and skin quality of the lower lid but please know that any provider who performs fat grafting to the area needs to be extremely proficient and experienced in this procedure and board certified in one of the plastic surgery related specialties.