Introduction
In the bustling city of New York in 2025, the pursuit of youthful and refreshed under - eye appearance through hyaluronic acid filling of tear troughs has gained significant popularity. Tear troughs, the hollows between the lower eyelid and upper cheek, can make individuals look tired and aged. Hyaluronic acid fillers offer a non - surgical solution to address this concern, providing natural - looking results with minimal downtime. However, the success of this procedure largely depends on the expertise of the doctor performing it. In this article, we will evaluate the top five selected doctors in New York City for hyaluronic acid filling of tear troughs, taking into account their experience, patient reviews, choice of fillers, and overall approach to the procedure.
Understanding Tear Troughs and Hyaluronic Acid Fillers
What are Tear Troughs?
Tear troughs are an anatomical area of the face, specifically the hollow located between the upper cheek and the lower eyelid region. They can be genetic or develop due to the natural loss of collagen as we age. As collagen levels decrease in the under - eye area, the skin becomes thinner and more transparent, making the underlying blood vessels more visible and creating a darkened under - eye area. This can give a person a tired or prematurely aged appearance.
How Hyaluronic Acid Fillers Work
Hyaluronic acid is a substance that occurs naturally in the body. Hyaluronic acid fillers are designed to restore lost volume in the tear trough area. When injected into the skin, these fillers bind to water, plumping the skin and increasing collagen production. This results in a more youthful - looking complexion, reducing the appearance of dark circles, fine lines, and puffiness under the eyes. Some of the commonly used hyaluronic acid fillers for tear troughs include Juvederm Volbella, Restylane, Restylane Eye Light, and Belotero Balance.
Evaluation of the Top Five Doctors in New York City
Dr. Michele Green
Dr. Michele Green is a world - renowned expert in the field of cosmetic dermatology, with over 25 years of experience. She is consistently rated as a top NYC dermatologist by Castle Connolly, Super Doctors, New York Magazine, and The New York Times.
- Experience and Expertise: Dr. Green has spent decades treating patients from around the globe for a wide range of skin concerns, including dark under - eyes. She has extensive knowledge of the facial anatomy and is an expert injector, which allows her to precisely place the hyaluronic acid fillers for optimal results.
- Choice of Fillers: She often uses hyaluronic acid fillers such as Juvederm Volbella, Restylane, Restylane Eye Light, and Belotero Balance. Each filler is carefully selected based on the patient's facial anatomy, skin concerns, and cosmetic goals. For example, Juvederm Volbella has a thin formulation that is suitable for delicate under - eye areas, while Restylane Eye Light is specifically designed to address under - eye hollowing and dark circles.
- Patient - Centered Approach: During the consultation, Dr. Green takes the time to assess the patient's under - eye hollows and develops a customized treatment plan. She ensures that the patient is a good candidate for the procedure and educates them about the process, potential side effects, and expected results.
- Patient Reviews: Patients praise Dr. Green for her professionalism, expertise, and the natural - looking results she achieves. They also appreciate her personalized approach and the fact that she takes the time to answer all their questions.
Dr. Brett Kotlus
Dr. Brett Kotlus is a cosmetic oculoplastic surgeon in NYC with specialized training in treating the delicate under - eye area.
- Experience in Oculoplastic Surgery: His background in oculoplastic surgery gives him a unique understanding of the complex anatomy around the eyes. This expertise is crucial when performing hyaluronic acid filling of tear troughs, as it requires precise injection techniques to avoid complications.
- Choice of Fillers: Dr. Kotlus recommends cross - linked hyaluronic acid (HA) gel fillers for the under - eyes. He still considers Restylane - L as the best under - eye filler due to its ideal balance of stiffness, cohesivity, and duration of effect. He also has experience with other fillers such as Belotero Balance, Juvederm Volbella, and Juvederm Vollure, and selects the most appropriate one based on the patient's needs.
- Avoiding Permanent Fillers: He is cautious about using permanent or semi - permanent injectable fillers under the eyes, as they are not reversible and can cause lumps and bumps if not placed correctly. His preference for reversible HA fillers shows his commitment to patient safety.
- Patient Reviews: Patients trust Dr. Kotlus for his expertise in treating under - eye concerns. They appreciate his honesty in discussing treatment options and his ability to achieve natural - looking results.
Dr. David Cangello
Dr. David Cangello is a plastic surgeon with extensive experience in tear trough filler treatments.
- Comprehensive Treatment Approach: Dr. Cangello assesses each patient's tear trough deformity and determines the best treatment approach, which may include dermal fillers, fat transfer, or lower eyelid blepharoplasty. This comprehensive approach ensures that the patient receives the most suitable treatment for their specific condition.
- Use of Cannula for Injection: He uses a small cannula to inject the filler into the under - eye area. This technique allows for controlled product distribution and reduces the risk of bruising. Most patients report minimal discomfort during the procedure.
- Patient - Focused Care: Dr. Cangello takes the time to explain the procedure, expected results, and aftercare instructions to his patients. He also provides support throughout the recovery process, ensuring that any concerns are addressed promptly.
- Patient Testimonials: Patients commend Dr. Cangello for his professionalism, skill, and the quality of his work. They note that he makes them feel comfortable and confident throughout the treatment process.
Dr. George Liakeas (Smooth Synergy Medical Spa)
Dr. George Liakeas is the medical director at Smooth Synergy Medical Spa in NYC, offering tear trough filler treatments.
- Skill in Injection Techniques: He is trained and experienced in injecting hyaluronic acid fillers quickly and easily. Using an ultrafine needle, he can minimize discomfort during the procedure. To further enhance patient comfort, he may anesthetize the treatment area with a numbing cream and uses fillers that contain a numbing ingredient like lidocaine.
- Variety of Filler Options: Smooth Synergy offers a range of hyaluronic acid fillers, including Restylane, Juvederm, and Belotero. Dr. Liakeas can select the most appropriate filler based on the patient's skin type, the depth of the tear trough, and their aesthetic goals.
- Focus on Safety: He emphasizes the importance of choosing a properly vetted doctor for tear trough filler treatments, as it is an off - label use for dermal fillers. His knowledge and experience in administering injectables safely give patients peace of mind.
- Patient Satisfaction: Patients are satisfied with the natural - looking results and the minimal side effects they experience after treatment. They also appreciate the personalized care they receive at the medical spa.
Dr. Darren M. Smith
Dr. Darren M. Smith is a board - certified plastic surgeon with an artistic eye for aesthetics and over 18 years of experience in enhancing and rejuvenating the delicate eye region.
- Precision in Treatment: Dr. Smith understands the distinct anatomical features of the tear trough region and uses specialized techniques to achieve the best possible outcomes. He typically injects the filler deep, just above the orbital bone, to ensure a natural appearance without surface lumpiness.
- Choice of Fillers: He commonly uses hyaluronic acid gel fillers like Juvederm and Restylane for tear troughs. For example, Juvederm Volbella XC is suitable for the under - eye hollows, and Restylane Lyft can address age - related volume loss. He determines the ideal filler based on the patient's individual needs.
- Minimizing Risks: Dr. Smith takes every precaution to ensure patient safety. He uses advanced techniques like small injection amounts and cannulas to minimize trauma and reduce the chances of extensive bruising. He also discusses all potential risks with the patient before the procedure.
- High Patient Reviews: Patients rave about Dr. Smith's expertise, the natural - looking results, and his friendly and professional demeanor. His numerous 5 - star reviews are a testament to his exceptional patient care.
Comparing the Doctors
| Doctor | Experience | Choice of Fillers | Technique | Patient - Centered Approach | Patient Reviews |
|---|---|---|---|---|---|
| Dr. Michele Green | Over 25 years in cosmetic dermatology | Juvederm Volbella, Restylane, Restylane Eye Light, Belotero Balance | Uses ultrafine needle for precision | Customized treatment plans, thorough patient education | Highly praised for professionalism and natural - looking results |
| Dr. Brett Kotlus | Specialized training in oculoplastic and cosmetic surgery | Restylane - L, Belotero Balance, Juvederm Volbella, Juvederm Vollure | Knowledge of facial anatomy for precise injection | Honest discussion of treatment options | Trusted for expertise in under - eye treatments |
| Dr. David Cangello | Extensive experience in tear trough filler treatments | Restylane®, Belotero | Uses cannula for injection to reduce bruising | Comprehensive treatment approach, patient support during recovery | Commended for professionalism and skill |
| Dr. George Liakeas | Experienced in injecting hyaluronic acid fillers | Restylane, Juvederm, Belotero | Uses ultrafine needle, may use numbing cream and lidocaine - containing fillers | Focus on patient comfort and safety | Satisfied patients with natural - looking results |
| Dr. Darren M. Smith | Over 18 years in enhancing the eye region | Juvederm, Restylane (e.g., Juvederm Volbella XC, Restylane Lyft) | Injects filler deep above the orbital bone | Takes precautions to minimize risks, discusses risks with patients | Numerous 5 - star reviews for expertise and patient care |
Considerations When Choosing a Doctor
Experience and Expertise
It is crucial to choose a doctor with extensive experience in hyaluronic acid filling of tear troughs. A doctor who has performed numerous procedures is more likely to have the skills and knowledge to handle any complications that may arise. Look for doctors with a background in cosmetic dermatology, oculoplastic surgery, or plastic surgery, as they have a deeper understanding of the facial anatomy and the appropriate injection techniques.
Choice of Fillers
Different hyaluronic acid fillers have different properties, such as stiffness, flexibility, and duration of effect. A good doctor will be able to select the most suitable filler for your specific needs based on your facial anatomy, skin type, and cosmetic goals. They should also be transparent about the available filler options and their pros and cons.
Patient - Centered Approach
A doctor who takes the time to understand your concerns and goals is more likely to provide a satisfactory outcome. They should conduct a thorough consultation, explain the procedure in detail, and answer all your questions. Additionally, they should provide clear aftercare instructions and support during the recovery process.
Patient Reviews and Testimonials
Reading patient reviews and testimonials can give you an idea of the doctor's reputation and the quality of their work. Look for reviews that mention natural - looking results, minimal side effects, and good patient care. However, keep in mind that individual experiences may vary.
Potential Side Effects and Risks
While hyaluronic acid filling of tear troughs is generally considered safe, there are some potential side effects and risks associated with the procedure. These may include:
- Swelling and Bruising: Mild swelling and bruising at the injection site are common and usually subside within a few days to a week. Applying ice packs can help reduce swelling, and avoiding blood - thinning medications before the procedure can minimize bruising.
- Tyndall Effect: This is a rare side effect that can cause a bluish discoloration in the injected area. It can occur if the hyaluronic acid filler is injected too superficially. However, it can be reversed with hyaluronidase to dissolve the filler.
- Infection: Although rare, there is a risk of infection at the injection site. To prevent this, the doctor should follow strict sterilization procedures, and patients should follow the aftercare instructions carefully.
- Vision Changes: In very rare cases, injecting the filler incorrectly into blood vessels in the tear trough region can lead to vision changes. This is why it is crucial to choose an experienced and qualified doctor for the procedure.
Conclusion
In 2025, New York City offers a wealth of options for hyaluronic acid filling of tear troughs, with several highly qualified doctors. Dr. Michele Green, Dr. Brett Kotlus, Dr. David Cangello, Dr. George Liakeas, and Dr. Darren M. Smith are among the top choices, each with their own unique strengths and areas of expertise. When considering this procedure, it is important to carefully evaluate your options based on the doctor's experience, choice of fillers, patient - centered approach, and patient reviews. By choosing the right doctor, you can achieve a more youthful and refreshed under - eye appearance with minimal risks and side effects.
If you are interested in hyaluronic acid filling of tear troughs, we encourage you to schedule a consultation with one of these top doctors. They will be able to assess your individual needs and provide you with a personalized treatment plan. Share this article with your friends and family who may also be interested in this procedure, and explore related topics such as other non - surgical facial rejuvenation treatments for a more comprehensive approach to looking and feeling your best.
