Many patients come to my office complaining of dark circles under their eyes and feel like that are looking tired. This can be caused from a number of things such as: lack of sleep, dehydration, recent illness, stress, hyperpigmentation, sinus issues, allergies, or recent crying. It can also be hereditary. It is important to assess the under eye area carefully and rule out all of the above factors, as well as obtaining a full patient history.
The tear trough assessment: When looking at the under eye area, during this assessment, I am of course looking at the condition of the under eye area. I am considering the age of the patient, health history, above factors I mentioned, and what the patients expectation of tear trough fillers are.
If your under eye area has large bags or looks like you are retaining fluid up under your eyes, I am sorry to tell you, you are not a good candidate for tear trough filler. If you are over the age of 40 and you have bags (herniated fat pad) or loose, crepy skin under the eyes, you are not a good tear trough filler candidate. These patient may be referred to a plastic surgeon for a consultation for a lower blepharoplasty. If we would put tear trough filler in one of these patient, it would make the area look worse, and potentially could cause them issues with swelling under the eyes and a blueish tint. It also could look lumpy because fluid under the eyes and loose skin can distort the filler.
The best thing is to be honest with our patients about the situation. I never want to over promise and under deliver. Even on a perfect tear tough filler candidate, there can be issues that arise. I tell all my patients that I am doing tear trough filler on, to never expect 100% correction. If they are not happy with that statement, or agree to the terms, then I will not do the procedure.
The perfect under eye filler candidate, has no medical history or factors we talked about above. They skin under the eye is taut and not puffy. There is a perfect little hollowness from the mid pupil point to the inner canthus and the vessels under the eye are not seen.
With a special technique, I can go in through the cheek and pop up that hollowness with filler to make the under eyes appear brighter and rejuvenated. In my video below, I inject the perfect candidate for tear trough filler. 1-2 syringes of filler is average for this procedure. Most of the time we inject the cheeks in combination with the tear trough filler. Again, we never overfill this area! The expectation is that the under eyes will look better but not 100% corrected. Check these before and after photos and the video posted below!