Introduction
The appearance of the under - eye area can significantly impact one's overall look. Tear troughs, which are the hollows between the upper cheek and the lower eyelid, can make a person look tired or older than they actually are. In New York City, there are many well - reputed doctors who specialize in eye tear trough filling, using various methods and fillers to help patients achieve a more youthful and refreshed appearance. In this article, we will explore some of the top doctors in the city and their expertise in this area, as well as provide information on tear trough fillers in general.
Understanding Tear Troughs and Tear Trough Fillers
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.
What do Tear Trough Fillers Do?
Tear trough fillers restore lost volume in the crease below the eye and improve the appearance of dark circles and under - eye bags. Tear trough fillers, with various hyaluronic dermal fillers, such as belotero, restylane, and juvederm, will help correct this tear trough deformity. Dermal fillers are designed to restore collagen production and replenish lost volume in the treatment area. 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. Hyaluronic acid is a component that is naturally produced by the body and helps plump the skin and increase collagen production, resulting in a more youthful - looking complexion. Using dermal fillers to treat the under - eye area can deliver natural - looking volume restoration and reduce the appearance of fine lines, puffiness, and dark circles.
Top Doctors for Eye Tear Trough Filling in New York City
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 believes that for the vast majority of people, the best fillers for the under - eyes are made of cross - linked hyaluronic acid (HA) gel. He does not recommend using permanent or semi - permanent injectable fillers under the eyes, such as BelaFill, Radiesse, silicone, and Sculptra, as these fillers are not reversible and can cause lumps and bumps that are difficult to correct. Dr. Kotlus still chooses Restylane - L as the best under - eye filler because of its great behavior profile, with the right balance of stiffness, cohesivity, duration of effect (about a year under the eyes), and relatively low swelling. He also frequently performs under - eye fat grafting, usually in conjunction with cosmetic eyelid surgery to blend and provide volume support to the areas around the eyes.
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. 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 often uses hyaluronic acid fillers such as Juvederm Volbella, Restylane, Restylane Eye Light, and Belotero Balance for tear trough filling. During the consultation, she will assess the patient's under - eye hollows to choose the right tear trough filler and develop a customized treatment plan.
Dr. David Cangello
Dr. David Cangello is a plastic surgeon with extensive experience in tear trough filler treatments. He understands that the tear trough deformity 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 can recommend the best option for tear trough filler based on the patient's individual needs, goals, and medical history, and will work with the patient to develop a customized treatment plan. He uses hyaluronic acid - based fillers, such as Restylane® or Belotero, which are safe, effective, and provide natural - looking results. The procedure involves injecting the filler into the under - eye area using a small cannula, and results can typically be seen immediately.
Dr. Zuckerman
Dr. Zuckerman can help patients reduce dark circles 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 (absorbs the least amount of water) 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. This treatment helps a patient appear rested and refreshed when the face is at rest and while smiling or otherwise facially animating. The treatment usually takes 10 - 20 minutes per session, and most patients require one treatment per year to maintain a continual effect.
Types of Tear Trough Fillers
Hyaluronic Acid Fillers
Hyaluronic acid (HA) fillers are the most commonly used for tear trough filling. They are soft, pliable, and most importantly, reversible. If there is a problem with a lump, bulge, discoloration (Tyndall effect), or bubble from the filler, it can be taken away with an enzyme injection that dissolves the filler. Here are some popular HA fillers for the under - eye area:
- Restylane - L: It has the right balance of stiffness, cohesivity, duration of effect (about a year under the eyes), and relatively low swelling. It can also be fine - tailored for deep or shallow injections by modifying the filler through hydration.
- Belotero Balance: This filler is popular for under - eyes because it's very forgiving for the injector. It is not very stiff and it tends not to lump up or cause discoloration, but the downside is that it doesn’t provide great lift if there is a deep tear trough.
- Juvederm Volbella and Juvederm Vollure: Volbella is softer and Vollure is stiffer. They cause less swelling than the older variety of Juvederm products and are good options for shallow (Volbella) and deeper (Vollure) injections under the eyes. However, a low incidence of inflammatory nodules (bumps) has been reported to occur after 4 months with Volbella.
- Restylane Refyne and Restylane Defyne: These fillers have a different type of cross - linking than regular Restylane, making them more “flexible” which can be of benefit in areas with a lot of facial movement. So far, there is no shown benefit over regular Restylane for the under - eyes.
- Restylane Silk: It is the thinnest, softest version of Restylane but it also has the highest swelling capacity, so it's not the best choice for the thin under - eye skin.
- Juvederm Ultra and Juvederm Ultra Plus: They swell more, are more likely to spread out, causing the treatment to be less accurate and the product to end up in a different place than where it was meant to be injected. So, they are not the ideal choices for the under - eye area.
- Juvederm Voluma: This thicker version of Juvederm is best for cheeks but not great for under - eyes. It tends to look lumpy and can also create long - term swelling, and it’s also resistant to dissolving with hyaluronidase.
Fat Injections
Fat injection, also known as fat transfer or fat grafting, is a permanent filler that uses the patient's own fat cells to add volume, similar to injectable synthetic fillers. Some surgeons, like Dr. Kotlus, frequently perform under - eye fat grafting, usually in conjunction with cosmetic eyelid surgery to blend and provide volume support to the areas around the eyes. However, fat grafting is less predictable than filler because some of the cells being injected will not survive, but even at a 50% survival rate, the benefits can be very worthwhile.
Considerations Before Getting Tear Trough Fillers
Candidate Selection
The best candidate for dermal filler injections in the tear trough is a healthy individual with noted volume loss in the under - eye area. 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 the consultation with the doctor, the doctor 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.
Pre - treatment Preparation
Before the procedure, patients should discuss their medical history and any medications they are taking with the doctor, as well as any allergies or sensitivities. In the days leading up to the appointment, patients should avoid taking blood - thinning medications or supplements such as NSAIDs (non - steroidal anti - inflammatory medications, anything containing ibuprofen, aspirin, or fish oil), as this can increase the risk of bruising. Additionally, it is recommended that patients avoid alcohol and caffeine in the days leading up to the appointment, as they can also increase the risk of bruising. On the day of the appointment, it is best to arrive with a clean and makeup - free face.
The Procedure and Recovery
The Procedure
The first step is to consult with the doctor, who will evaluate the targeted treatment area and the skin’s elasticity, confirm 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. Some dermal fillers are also compounded with lidocaine to further reduce pain. The doctor will inject the dermal fillers directly into the skin in tiny amounts using an ultrafine needle or a cannula. 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.
Recovery
After getting tear trough filler, it is normal to experience some mild swelling, bruising, and redness around the injection site. These symptoms usually subside within a few days to a week and can be managed with ice packs or over - the - counter pain medications such as ibuprofen. Patients should avoid rubbing or massaging the area for at least 24 hours after the procedure, as this can cause the filler to shift or become dislodged. It is also recommended to avoid strenuous exercise, alcohol, and blood - thinning medications or supplements for at least 24 hours after the procedure. While the results of tear trough filler are immediate, it may take a few days for the full effects to be visible as any swelling or bruising subsides.
Cost and Duration of Results
Cost
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. Typically, fillers cost $1000 or more per syringe, depending on the exact filler. During the consultation, the doctor will assess the patient's tear trough, cosmetic concerns, and goals to choose the best - suited dermal filler product and recommend the total number of syringes needed and the cost of treatment.
Duration of Results
Dermal fillers typically last for anywhere from six to twelve months, depending on the exact filler used. The rate of absorption of a dermal filler varies for each patient depending on their metabolism and the location where the filler was injected. Eye rejuvenation with tear trough filler treatment can be repeated on an annual or biannual basis to maintain the desired cosmetic results.
Side Effects and Risks
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. 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. To prevent any serious or adverse side effects from developing, it is important to have the tear trough filler injections performed by an expert, board - certified injector.
Conclusion
Eye tear trough filling is a popular non - surgical cosmetic procedure in New York City that can help patients achieve a more youthful and refreshed appearance. There are many well - reputed doctors in the city, such as Dr. Brett Kotlus, Dr. Michele Green, Dr. David Cangello, and Dr. Zuckerman, who have the expertise and experience to perform this procedure safely and effectively. Hyaluronic acid fillers are the most commonly used for tear trough filling, but other options like fat injections are also available. Before getting tear trough fillers, patients should carefully consider their candidacy, prepare properly for the procedure, and be aware of the potential side effects and risks. If you are interested in this procedure, it is recommended that you schedule a consultation with a qualified doctor to discuss your options and determine the best treatment plan for you.
Are you tired of looking tired? Take the first step towards a more youthful and refreshed appearance. Contact one of the top doctors in New York City for a consultation on eye tear trough filling today! Don't forget to share this article with friends and family who might also be interested in this topic.
