Introduction
The appearance of the under - eye area can significantly impact one's overall look. Tear troughs, those creases between the lower eyelid and upper cheek, can make a person appear tired and aged. Hyaluronic acid filling of the tear trough has become a popular non - surgical solution in New York City. In this article, we will explore the ranking of doctors for this procedure, along with some key aspects related to it. We'll also briefly touch on cases of dental plastic surgery, although the primary focus will be on tear trough filling.
What are Tear Troughs?
A tear trough is an anatomic area of the face, the hollow located between the upper cheek and the lower eyelid region. Tear troughs can cast a shadow and create the appearance of a darkened under - eye area, making one look tired or prematurely aged. They can be genetic, but they may also present due to the natural loss of collagen that occurs as we age. Reduced collagen levels in the under - eye area lead to transparent, thin skin, increasing the visibility of underlying blood vessels and creating a darkened under - eye area.
How Tear Trough Fillers Work
Tear trough fillers are a non - invasive cosmetic treatment option for rejuvenation of the under - eye area. Tear trough filler injections are placed between the lower eyelid and upper cheek to replenish volume and smooth out the under - eye hollows that can cast a shadow and result in the appearance of dark circles. The best types of filler for the under - eye area are hyaluronic acid fillers, such as Juvederm, Restylane, or Belotero. Hyaluronic acid is a substance that occurs naturally in the body, and HA fillers work to restore lost volume and hydration in the tear troughs to correct tired - looking eyes and under - eye bags.
These specific fillers have a soft formulation to enhance your natural appearance for a rejuvenated look. When injected into the tear trough area, dermal fillers work to reduce the appearance of dark circles and shadowing under the eyes. The preferred dermal fillers for this treatment area are composed of hyaluronic acid gel and have a small particle size.
Ranking of Doctors for Hyaluronic Acid Filling of the Tear Trough 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 spent treating the most discerning patients from around the globe for a myriad of skin concerns, such as dark under - eyes, sun damage, fine lines and wrinkles, hyperpigmentation, acne, and acne scars. She is consistently rated as a top NYC dermatologist by Castle Connolly, Super Doctors, New York Magazine, and The New York Times due to her expertise and dedication to her patients.
At her private dermatology office in Manhattan’s upper east side neighborhood, Dr. Green offers a host of non - invasive cosmetic procedures for rejuvenation, including under - eye fillers, Botox, laser treatments, microneedling, other various dermal fillers, chemical peels, and more. She is an expert injector who can work with patients to ensure that they are a good candidate for tear trough fillers and develop a customized treatment plan that caters to their unique skin care concerns and aesthetic goals.
Dr. Brett Kotlus
Dr. Brett Kotlus is a Cosmetic Oculoplastic Surgeon in NYC. He has extensive experience and specialized training in oculoplastic and cosmetic surgery. Dr. Kotlus is very particular about the choice of fillers for the under - eye area. He avoids using permanent or semi - permanent injectable fillers like Bela Fill, Radiesse, silicone, and Sculptra under the eyes as they are not reversible and can cause difficult - to - correct lumps and bumps.
He recommends cross - linked hyaluronic acid (HA) gel fillers for the under - eyes, such as Restylane - L, as it has a great behavior profile with the right balance of stiffness, cohesivity, and duration of effect, and relatively low swelling. Dr. Kotlus is skilled at managing issues related to under - eye filler treatments and frequently corrects under - eye filler problems in his NYC practice.
Dr. David Cangello
Dr. David Cangello is a plastic surgeon with extensive experience in tear trough filler treatments. He can recommend the best option for tear trough filler based on an individual's needs, goals, and medical history, and will work with patients to develop a customized treatment plan to achieve their desired results.
He explains the tear trough deformity well, which can occur due to a combination of factors such as aging, genetics, loss of facial fat, loss of skin elasticity, and laxity of facial ligaments. Dr. Cangello's patients have reported positive experiences, with one patient saying, “He is amazing! Made me feel super comfortable as soon as I met him. He is got a lot of patience, explains every little detail and is a great listener. Not to mention his work is absolutely amazing.”
Dr. Zuckerman
Dr. Zuckerman can help patients reduce dark circles, regardless of age, with under - eye dermal filler injections. He uses Restylane - L, a hyaluronic acid filler with lidocaine, which is FDA - approved for treating the under - eye area. It is also the least hydrophilic of hyaluronic acid fillers, and therefore minimizes swelling.
Dr. Zuckerman injects deep into the tissues, near the bone, and can inject up to 1 cc + of filler per eye. His treatment helps patients appear rested and refreshed when the face is at rest and while smiling or otherwise facially animating. Most patients require one treatment per year to maintain a continual effect, and the treatment lasts up to one year.
Dr. George Liakeas (Smooth Synergy Medical Spa)
At Smooth Synergy Medical Spa, Dr. George Liakeas, MD, is the medical director. He has expertise in tear trough filler treatments. The procedure at this spa is simple and usually takes between 15 minutes to an hour, depending on the treatment area. Dr. Liakeas will evaluate the face, mark strategic injection points for placement, and use a super - fine needle to inject along these predetermined sites.
He is trained and experienced in minimizing discomfort during the injection process. Additionally, he may anesthetize the treatment area with a numbing cream, and there are fillers that contain a numbing ingredient, such as lidocaine. Smooth Synergy prides itself on being one of the best spas in NYC, offering a complete line of non - surgical facial treatments.
Dr. Neal Goldberg
Dr. Neal Goldberg is an extensively trained aesthetic plastic surgeon. He offers tear trough filler treatment with Restylane - L® to provide patients with effective and natural - looking results of the highest quality. Dr. Goldberg can assess whether a patient is a suitable candidate for tear trough fillers.
He also considers if combining injections with a more long - term treatment, like lower blepharoplasty, is advised to achieve the best outcome. The treatment with tear trough fillers at his practice takes place during a convenient in - office treatment, and patients typically report excellent results that last between six months and one year.
Dr. Neinstein (Neinstein Plastic Surgery)
At Neinstein Plastic Surgery, the approach to tear trough fillers is unique. They inject very deep (almost directly on the cheek bone starting about half way up the nose) and slowly move a small wave of the hyaluronic acid up towards the tear trough area. This technique is safe, predictable, and dramatically reduces the risk of bruising in the area.
The practice also takes measures to minimize discomfort during the injection process, such as numbing the skin and using cannulas instead of needles under the skin. Patients are provided with detailed after - care instructions to ensure a smooth recovery.
Dr. Mesa
Dr. Mesa is a board - certified plastic surgeon with a practice focused on cosmetic procedures of the face, neck, breast, and body. He has extensive training at Harvard University and other top institutions and has earned a reputation for achieving exceptional results. Dr. Mesa performs tear trough correction with meticulous care to achieve results that appear refreshed, youthful, and natural.
He also offers the option of combining tear trough fillers with platelet rich plasma (PRP) to enhance the results and reduce the appearance of dark circles.
Comparison of Fillers for Tear Troughs
| Filler Name | Characteristics | Advantages | Disadvantages |
|---|---|---|---|
| Juvederm Volbella | The first FDA - approved dermal filler for treating tear troughs, contains the thinnest formulation of the Juvederm family. Has patented Vycross technology for smooth and even distribution under the skin. | Soft formulation for a natural - looking rejuvenated look. Can address tired - looking eyes and under - eye bags. | A low incidence of inflammatory nodules (bumps) have been reported to occur after 4 months. |
| Restylane | Good balance of stiffness, cohesivity, duration of effect (about a year under the eyes), and relatively low swelling. Can be fine - tailored for deep or shallow injections by modifying the filler through hydration. | One of the most popular and effective fillers for under - eyes. Safe and provides long - lasting results. | - |
| Restylane Eye Light | Newer dermal filler, FDA - approved in 2023 for use under the eyes. Uses crosslinking and patented NASHA technology to erase under - eye hollowing and dark circles caused by lost volume. | Designed specifically for the under - eye area, can effectively address volume loss and dark circles. | - |
| Belotero Balance | Ultra - thin and flexible formulation, can eliminate the risk of the Tyndall effect (a bluish hue in the injected area). Provides a soft and even correction in the skin. | Highly effective for tear troughs, very forgiving for the injector and less likely to cause lumps or discoloration. | Doesn't provide great lift if there is a deep tear trough. |
| Restylane - L | FDA - approved for treating the under - eye area. Least hydrophilic of hyaluronic acid fillers, minimizing swelling. | Good for reducing dark circles and providing a natural look. Long - lasting results. | - |
Patient Suitability for Tear Trough Fillers
The best candidate for dermal filler injections in the tear trough is a healthy individual with noted volume loss in the under - eye area. However, if there is excessive wrinkling or skin under the eyes with fat deposition, tear trough fillers may not be the best course of treatment.
During a consultation with a doctor, they will physically evaluate the under - eye area to determine if tear trough fillers are the correct treatment or if another cosmetic procedure is better suited. If a patient has naturally darker skin pigmentation in the under - eye area, under - eye fillers are ineffective as they may only emphasize the appearance of the dark circles. In such cases, other treatments like the Mesopeel Periocular®, a specially formulated chemical peel, may be recommended.
The Procedure for Tear Trough Filler
The first step for having under - eye dermal fillers is to consult with a doctor, such as Dr. Michele Green in her office on the upper east side of Manhattan. The doctor will evaluate the targeted treatment area and the skin’s elasticity, confirm if the patient is a good candidate for tear trough fillers, and determine the appropriate dermal filler product and the number of syringes required to produce the best results.
A local anesthetic will be generously applied to the entire treatment area one hour before performing any injections to ensure that the procedure is as comfortable as possible. Additionally, the dermal fillers used for the under - eye area are often compounded with lidocaine. The doctor will inject the dermal fillers directly into the skin in tiny amounts using an ultrafine needle. While some providers prefer using a cannula, some doctors like Dr. Green use an ultrafine needle to allow for precision in the tear trough injections.
Immediately upon completion of the procedure, ice will be applied to the treatment area to help prevent any swelling that may occur, and aftercare instructions will be provided. After the initial treatment with dermal fillers for correction of tear troughs, the doctor will typically schedule a two - week follow - up to ensure that the treatment was satisfactory and determine whether any touch - up of the hyaluronic acid dermal filler is needed.
Side Effects and Safety of Tear Trough Fillers
There typically are no major side effects associated with receiving under - eye fillers. However, it is possible to develop a mild amount of swelling or bruising at or around the injection sites. Swelling and redness are common side effects at the site of injection, and icing the treated area immediately after the injections will minimize this reaction. Bruising is another potential side effect. To decrease bruising, doctors may recommend discontinuing any blood thinners as well as NSAIDs such as Advil, aspirin, ibuprofen, or Aleve, as these medications can worsen bruising. Additionally, patients prone to bruising can take Arnica Forte, an herbal supplement, to help prevent and heal bruises faster.
The Tyndall effect is a rare side effect that leads to the development of a bluish discoloration after some hyaluronic acid fillers are injected. The injection area can appear blue if the hyaluronic acid filler is injected too superficially. This color change can last several months in the treated area and can be reversed with hyaluronidase to dissolve the dermal filler. Some rare but more serious side effects include changes in vision, vascular occlusion, signs of infection at injection sites, allergic reaction to the dermal filler product, worsening bruising or swelling, numbness, and persistent pain.
In order to prevent any serious or adverse side effects from developing, it is important to have tear trough filler injections performed by an expert, board - certified injector such as the doctors mentioned above.
Cost of Tear Trough Fillers
The total cost of tear - trough filler treatment depends on several factors, such as the medical professional performing the procedure, the geographic location of the office, the type of filler used, and the amount of filler needed. Although it may be more costly to have the procedure done by a more experienced, board - certified dermatologist or plastic surgeon, it is important to be very selective about the provider to ensure that unwanted side effects are avoided.
Typically, fillers cost $1000 or more per syringe, depending on the exact filler. During a consultation with a doctor, they will assess the tear trough, cosmetic concerns, and goals to choose the best - suited dermal filler product and will be able to recommend the total number of syringes needed and the cost of treatment. For example, at Dr. Neal Goldberg's practice, the cost of tear trough correction is approximately $950 per injection, but it depends on various factors specific to the patient's treatment plan.
Complementary Treatments with Tear Trough Fillers
Botox is one of the most popular cosmetic treatments that can be combined with tear trough fillers. Botox is effective in softening the appearance of fine lines and wrinkles, including around the eyes. It is commonly used to treat the outer canthal lines (crow’s feet) that appear as a result of smiling, squinting, and other repeated expressive movements. Doctors like Dr. Michele Green often treat patients for tear troughs and crow’s feet in the same visit, using dermal filler and Botox to achieve total rejuvenation of the eye area.
Under - eye dark circles and wrinkles can also be improved through microneedling. Microneedling® uses a tool with tiny surgical - grade needles embedded in the tip to create microscopic wounds on the surface layer of the skin (the epidermis). Through the natural wound - healing process of the skin, these micro - injuries are repaired as new, healthier skin cells grow, and new collagen and elastin are produced. This helps to plump and firm skin, diminish signs of aging, and minimize the overall appearance of dark circles. The effects of microneedling can be further enhanced by combining the treatment with platelet - rich plasma (PRP).
Thermage is the gold standard in facial skin tightening and can improve skin elasticity in the delicate under - eye area. It uses radiofrequency energy to stimulate collagen production in the skin. A chemical peel can revitalize baggy or sagging skin under the eyes by removing dead skin cells along the superficial top layer of the skin, allowing healthy new skin cells to be exposed. Non - ablative laser resurfacing treatments, such as Fraxel and eMatrix, can be used to tighten and firm
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