One of the most popular treatments offered at Nuance Facial Plastics is our Tear Trough Fillers.  As eye bags can give a “tired” or “sick” look, improving these can have a dramatic effect on the appearance and one’s sense of self.  Though not all patients with “eye bags” would benefit from fillers, we offer all treatments from fillers through lower eyelid lift surgery to improve this part of the face.  As humans, our gaze is drawn to the eyes of the person we are talking to, and therefore, improvement in the appearance of the eyes can have a strong impact on the entire face.  Eye bags tend to appear the worse in overhead lighting, as the “mountain” of the eye bags cast a shadow on the “valley” of the tear trough.  Tear trough fillers aim to raise this “valley” to soften the shadow and give a more smooth transition from the lower eyelid to the cheek.

Anatomy of Eye Bags and Tear Troughs

The eyes are contained in a bony orbit, and within this orbit, there are muscles, fat, the eye, blood vessels, and nerves.  It is important to note the wide variety of tissues involved with the eye because they all matter.  A bone that is set farther back means that the “container” is smaller, and more of the contents of the orbit are supported by the facial tissues.  A larger orbit gives a more “deep-set” eye and may give the appearance of a more prominent brow.  It is important to know the relationship between the anatomy and the eye bags, as some configurations can be treated with tear trough fillers, and others are better addressed with surgical solutions.

Causes of Eyelid Bags

It is important to first distinguish among different conditions that lead to eyelid bags.  
A very common cause of eyelid bags is the position and covering of the inferior orbital rim.  Feel the bone under your eye.  If this is positioned farther backward, then the eye can have a “bulging” look, and the fat pads of the eyes can appear more prominent.  If it has a normal position but thin tissue overlying it, then you may be a candidate for tear trough fillers.
Another common cause of eyelid bags in the early Spring and Autumn months is fluid retention due to allergies.  This is important to recognize and treat because any interventions done (such as fillers or surgery) to the eyes when they have swelling can give even more swelling, so this is where we start.  There are also some rare conditions such as thyroid disorders that can lead to fluid retention in the eyelids.  How do you know if you have fluid under the eyes?  First of all, the fluid may come and go, giving the appearance of eye bags that fluctuate in size during the day or at different times of the year.  They tend to be worse in the morning (after a night of lying down and gravity working against you), and best in the evening.  They tend to be worse during allergy season.  They may improve when you treat your allergies.  For simple over the counter solutions, check out my blog post on the subject here.
Eye bags can be caused by fat from the orbit bulging forward.  There are three fat pockets in the lower eyelid, and they can gain prominence over time not because they are growing, but rather because the tissue that holds them back tends to relax with time.  This fat cannot be removed without surgery, though the lower eyelid lift, or lower blepharoplasty, is a great treatment to reduce these fat pads.  To visualize these fat pads, having a person facing you take a picture of your face at rest, and then with you (again in the same position) looking upward.  This position pulls the fat pads into view and is quite hard to see for yourself in the mirror for obvious reasons (if these are not obvious, please do try and e-mail us with the results).
The last causes of lower eyelid bags are from excess skin of the lower eyelid, or from a thick orbicularis oculi muscle.  The skin can be removed with a lower eyelid lift, but I prefer to leave the muscle intact, as removal of the orbicularis oculi muscle can lead to unwanted complications.  Instead of removal, I suspend it to distribute it more evenly and prevent it from bunching up and creating an “eye bag” made of muscle.

Treating Eyelid Bags with Tear Trough Fillers

As I mentioned earlier, the anatomic configuration that benefits the most from tear trough fillers is people without too much excess eyelid fat, that has a full eyelid casting a shadow on the orbital rim.  This is treated with fillers, and the technique that I use involves using a cannula to place the filler material between the muscle and the periosteum, or the thin tissue covering the bone of the orbit.  
For a typical office visit, after a decision is made to treat with tear trough fillers, the cheeks are cleansed with alcohol, and then a numbing shot is used, similar to getting a dental procedure done.  After this is allowed to sit for a couple of minutes, a needle is used to make a pinpoint hole in the skin, and then a cannula is threaded through this hole and to the tear trough.  The filler is then injected, and we watch in real-time as the tear troughs, the hollow under the eyes or the “undereye circles” are softened.  Once the procedure is complete, about 5-10 minutes after the numbing shots are given, the treatment is done, and the patients go about their daily activities, with the exception of heavy lifting and jarring activity, as such things can increase the risks of bruising and swelling in the short term.  Normal activities are resumed 2-3 days after treatment.

Frequently Asked Questions

Q: Can tear trough fillers be done on all different skin types?
A: Yes, tear trough fillers are often done on patients that represent the whole spectrum of skin colors
Q: Can I have tear trough fillers if my crow’s feet were treated with Botox?
A: Yes, you absolutely can, and we often do these two treatments in the same sitting, so they are safe to use in combination and get great results when done so in appropriate patients.
Q: My nurse injector told me that the area around the eyes is “no man’s land” for fillers.  Are tear trough fillers dangerous?
A: Though many people are not comfortable with treating this area with filler, it is something that I consider safe and routine.  No medical treatments are without risk, but this is not one that I consider particularly “risky”.
Q: Can I get tear trough fillers on the day of my consultation?
A: Yes, we often treat during a consultation, though if you are interested in this, it is best to let us know that you would like a consultation and possibly a treatment on the same day so that we can schedule you so.
Q: Are tear trough fillers painful?
A: I cannot predict your pain or discomfort, but if I can use my experience as the person doing the treatment, I often hear that it is less painful than getting Botox.
Q: What products do you use as Tear Trough Filler?
A: Soft fillers work best here given the very thin soft tissue between the skin and bone.  A thicker filler would be too “lumpy” and unnatural appearing.  My preferred products are Restylane, Versa, Belotero, and Volbella.  

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309 S Sharon Amity Rd
Ste 202
Charlotte, NC 28211

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