Cheek and Tear Trough Filler
As we age one of the effects is the downward sag of the midface. This results in the lateral extension of the tear trough until it effectively turns the youthful curve of the cheek into two curves, the lower of these curves extends into the nasolabial lines and into the jowl on the jawline. A facelift is an effective approach to the jowl, but doesn't replace the missing volume. A better solution is therefore to replace the missing volume, hence the popularity of deep cheek filler.
This is particularly effective on its own in your 40s and 50s, and can be added to a facelift in your late 50s and 60s. I use the more viscous long acting hyaluranic fillers as they are effective, reasonably long lasting and crucially reversible. The technique is shown below. There has been debate as to how much filler is required. I like the less is more approach, and will put as little as 0.6ml in each side in the first instance, especially in a younger patient. If your cheeks are flat then you will normally need a syringe each side.
If you are considering tear trough filler always appraise your cheeks first, as cheek filler is a more effective approach to the lower part of the tear trough. I recomend doing the cheeks first, as you can then better judge how much filler you need for the tear trough.
Tear Trough Fillers
A classic complaint for many is that of dark circles under the eyes. This is phenomenally difficult to correct surgically. One of the most effective techniques is to use filler to plump up the tear trough. The results are immediate and last from 6 to 9 months.
This is an advanced treatment with fillers and there have been variable results. The secret is to use a thick but not too thick filler, and to make absolutely sure that all the filler is injected deep to the orbicularis muscle directly on the bone. This can be slightly unnerving for the patient, as the tip of the needle needs to tap against the bone. The pressure on the plunger also needs to be released for some seconds before the needle is withdrawn to allow the build up of pressure in the barrel of the syringe to ease. If this is not done a trickle of filler comes out anterior to the muscle and can give a small lump. In my opinion less is more and I would recommend using only half a syringe each side initially. You can always top up after two weeks.
The skin is very thin in this area so bruising is more common and more visible, but will wear off over a few days and can always be hidden with foundation.
As ever with the hyalan fillers - if you do not like the result the filler can be reversed with hyaluronidase.