Under Eye Filler (Tear Trough) Treatment in Weston, Fort Lauderdale, and Miami

Q: What is Tear Trough Treatment?

The tear trough (also known as the under eye hollow) is the anatomic boundary between the lower eyelid and the cheek. While a noticeable tear trough can be observed at any age, it is more commonly associated with aging and facial volume loss. It is also exacerbated by fat herniation in the lower eyelid. While surgery can correct this, many patients choose a non-surgical approach with facial filler.

Q: How long do the results of under eye treatment last?

Fillers in the tear trough last a very long time, and most patients require maintenance treatments after 1-3 years.

Q: Is there much discomfort during under eye filler treatment?

Patients are surprised to learn that the tear trough is probably the least painful area treated in the face, but can still elect to use a pre-treatment numbing cream. Our gentle technique and the use of very small needles enhances comfort as well.

Q: What is the expected recovery after under eye treatment?

Some minor swelling is expected after treatment. This is usually minor and resolves within a week. Some patients will also develop minor bruising that can usually be covered with makeup. Patients should avoid exercise for twenty-four hours after the procedure to minimize swelling. Otherwise, patients can resume work and normal activities.

Q: Why choose Dr. Greene for my under eye filler treatment?

Dr. Greene and Holly have both administered thousands of facial filler treatments. Dr. Greene is also a national trainer for Allergan (Botox and Juvederm portfolio of fillers) and is recognized globally as an authority on facial fillers. Holly was personally trained by Dr. Greene many years ago, and has been in the practice for over 10 years. While there are unique nuances to their techniques, they share similar approaches and philosophies. Together they have established a center of excellence for facial injectable treatments in South Florida.

Q: What are the potential side effects of tear trough filler?

The majority of patients only experience mild swelling and bruising that can be camouflaged with concealer makeup. While patients with thin skin are perhaps more susceptible to bumps or visible filler, this can be avoided with expert judgment and careful technique. Rarely patients may encounter delayed or prolonged swelling. This is almost always due to an incorrect filler choice or due to the use of blunt cannula techniques, with superficial placement of filler and additional trauma to the soft tissues. This superficially placed filler is more easily visible, prone to migration, and can generally only be remedied with dissolving the filler. A careful needle technique has a significantly lower risk of edema or visible filler.

Q: What should I do after getting tear trough filler?

Patients are instructed to avoid exercise for at least 24 hours. It is also recommended to sleep with slight head elevation for 1-2 nights. Finally, activities that could put pressure on the eyes, like wearing goggles or a tight mask should be avoided for two weeks.

For many patients, both young and old, filler treatments to the under eye area are a safe and effective alternative to surgery. Many patients are unhappy with the shadows and depressions that occur under the eyes. This can be due to genetics, but is also a common sign of aging. Dr. Greene and Holly are established experts in treating the tear trough area and have performed thousands of these treatments. Patients from all around the country visit our office to correct their tear trough deformities. This is a complex anatomic area that requires extensive knowledge of facial anatomy, as well as expert technique in order to provide natural-looking and long-lasting results.

THE TEAR TROUGH AND DARK CIRCLES UNDER THE EYES

The tear trough, also known as a nasojugal groove, extends from the inner corner of the eye, following a semicircular arc and transitioning to the palpebromalar groove. A deep tear trough can create a shadow that is perceived as a dark circle below the eye. It also creates a noticeable division between the lower eyelid and cheek that is an early sign of aging around the eyes. Patients with deep tear troughs often complain that they look more tired and older than they really are.

Blog post by Dr. Ryan Greene

Patients often ask me - Do you use blunt a blunt cannula for the tear trough?

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While a tear trough deformity can be corrected surgically by repositioning fat in the lower eyelid, treatment with filler has become a popular alternative to surgery. Many patients prefer a non-invasive approach, in order to avoid the risks and potential complications of surgery. Treatment with a filler such as Restylane can provide a patient with a long-lasting natural result, often longer than one year, with minimal downtime.

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WHO IS A CANDIDATE FOR TEAR TROUGH FILLER TREATMENT?

Patients who are candidates for treatment have darkening below the eyes that can be attributed to a loss or lack of volume below the lower eyelid. Sometimes, these dark circles are due to pigmentation issues that may not be addressed with filler; additionally, patients with significant fat herniation in the lower eyelids may limit the improvement that can be achieved with treatment. Selecting appropriate patients for tear trough treatment requires careful judgment and significant experience with these treatments. Excellent candidates tend have good skin elasticity and adequate skin thickness. The position of the orbital rim to the tear trough is also an extremely important consideration. Assessing one’s candidacy for tear trough filler treatment requires an in-person consultation. And even patients who are not ideal candidates can often be treated, but this is also discussed during the consultation.

THE CHOICE OF FILLER FOR THE TEAR TROUGH

Restylane (as well as Restylane Eyelight, which is the same filler in different packaging) is an ideal filler choice for the tear trough for many reasons. Its unique consistency creates a natural rejuvenation in the tear trough, but it is less hydrophilic than many other fillers that are associated with puffiness and swelling. It is also long-lasting, often greater than a year. And finally, since it is a hyaluronic acid filler, it can be removed with the hyaluronidase treatment, if necessary.

Unfortunately, many fillers are not ideal for use in the tear trough. Some HA fillers exert a hydrophilic plumping effect under the eyes, creating a very conspicuous ‘puffy’ look that can persist for several months. And while many injectors have tried filling the tear trough with collagen, Artefill, and even silicone, these other filler materials have been associated with unwanted side effects and complications.

DO YOU USE A CANNULA FOR UNDER EYE INJECTIONS?

Patients often inquire if we use blunt cannulas for the tear trough. In our office, we use a much safer needle technique, which avoids many of the cosmetic complications patients experience due to cannula use in the tear trough. The needle technique precisely places the filler into the tear trough, in a very predictable deep plane. With a cannula, the filler is often incorrectly placed too superficially, and is very prone to injector error. In addition, the filler is often inadvertently placed too low into the cheek. On a daily basis, we see patients treated elsewhere who had filler placed incorrectly using a cannula, typically presenting with puffy, lumpy filler below the tear trough. The good news is that this can be addressed by dissolving the misplaced filler, and patients can then be treated with a needle technique.

THE IMPORTANCE OF EXPERIENCE IN TEAR TROUGH FILLER INJECTIONS

Dr. Greene and Holly are both very experienced with tear trough filler treatment. Successful execution of filler treatments in the tear trough requires significant skill, experience, and judgment. With poor judgment and unskilled technique, the complication rate is high and patient satisfaction is low. Patients who wish to address their tear troughs with filler should only choose an injector who is skilled in tear trough treatments. Our office routinely sees patients who have been treated elsewhere and are unhappy with their tear trough treatments. We have extensive experience with the use of hyaluronidase, an enzyme that can dissolve filler, and in the correction of poor treatment outcomes.

WHAT ELSE IS IMPORTANT TO KNOW PRIOR TO TREATMENT?

1) Surprisingly, injections under the eyes are not painful. Patients are often anxious about their upcoming treatment, but are pleasantly surprised to find that there is virtually no discomfort.

2) Mild bruising is common after filler treatment of the tear trough, but typically resolves within a week. Patients are advised not to undergo treatment if they have an important event around the corner.

3) Most patients are pleased with the outcome of treatment, even if their results are subtle.

4) While many patients only require one treatment with Restylane, patients with very deep tear troughs or poor skin quality may ultimately need additional treatments.

5) As with all filler treatments, it is essential that patients avoid aspirin, ibuprofen, or any other medication/supplement that may promote bleeding for a few days prior to treatment.