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Three Ways to Maximize Your Trough Filler

Bags under your eyes are one of the most common complaints we see in our practice. I had previously written about treatment options, and today I wanted to comment on specific ways you can optimize filler results. Injecting the tear troughs is a very challenging procedure and should be done by expert injectors with experience in this area. The reason is the lower lid is a delicate area, and injections must be performed precisely. In addition, there are potential catastrophic results if not done correctly.

Finding the Right Dermal Filler

First, make sure you choose the best filler for this area. As I mentioned, this region is very delicate. The skin is thin and the product needs to be injected in the correct plane. If done too superficially, there is a chance you’ll notice the filler. So what filler should you choose? The best fillers are hyaluronic acid (HA) fillers.

The biggest advantage of hyaluronic acid fillers is the ability to dissolve them if you get lumps you can’t get rid of. In the past, there were only a few HA products on the market, dominated by Galderma’s Restylane and Allergan’s Juvederm Ultra or Ultra Plus. Though both are HA products, they are manufactured differently and have different performance profiles. Restylane is less hydrophilic—meaning it draws in less water than the Juvederm fillers. This translates to less swelling.

This is desirable in the delicate area of the tear troughs. I tried Juvederm Ultra and Ultra Plus and was disappointed in the noticeable swelling that resulted and believed Restylane is better for the tear troughs. Now, however, both Allergan and Galderma have designed various types of HA fillers with different qualities. This has resulted in both brands offering different fillers aimed at different areas of the face.

In my opinion, there is no major advantage one company has over another since each company has a variety of fillers one can choose from. Allergan now has their new Vycross technology fillers like Volbella, Vollure, and Voluma. These are much less hydrophilic than Ultra and Ultra Plus, thus giving me the option to stick with one product line. I like Volbella because it’s both hydrophilic and, it’s designed for very superficial injections.

So the undesirable Tindel effect (that bluish tint) seen with too superficial injections is very rare with Volbella. I also like the way it injects. Another benefit is it lasts a long time. Even before the arrival of these new fillers, HA fillers in the tear troughs tend to last much longer than around the mouth. In my experience, these fillers should last one to two years.

However, I also believe Galderma’s Restylane products are excellent choices for the tear troughs. I definitely don’t recommend a filler like Radiesse (calcium hydroxyapatite) or Sculptra. These are too thick and you can’t dissolve them. The reason it’s important to be able to dissolve the filler is due to the high possibility of touch up. I counsel patients there is about a 10% chance that I will need to either dissolve a portion or inject more filler.

Maximizing Your Results

The second thing that will maximize your result with tear trough filler is to use a microcannula technique. I’m a big fan of using the microcannula in the tear troughs. Because I’m using a cannula, the risk of bruising goes down significantly. In addition, and perhaps the most important advantage, there is much lower risk of inadvertent embolization of the filler into a blood vessel.

An extremely rare complication of filler injections is embolization—where the filler is injected directly into a blood vessel and blocks that vessel. That can result in vascular compromise. Horrible outcomes can include blindness and tissue death. While a microcannula doesn’t guarantee no embolization, it’s very rare because one is injecting filler through a blunt opening, vs a sharp needle.

The final thing to optimize your filler result is to see a board certified doctor with experience injecting the tear troughs. Facial plastic surgeons, plastic surgeons, dermatologists, and oculoplastic surgeons are all specialists with required training in injecting. Even then, you should see a doctor who has experience injecting the tear troughs because this is a difficult area to inject well.

While I am aware there are well qualified nurse injectors and physician assistants (some who may even be outstanding), it is still crucial these injectors are working under the oversight of a board certified physician. I don’t recommend choosing an injector based on the lowest price. The adage, “you get what you pay for,” certainly applies to your face.

For more information on tear trough filler injections, please schedule a consultation with Dr. Kenneth Yu or contact our Concierge Patient Coordinator at (210) 876-6868.