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Sometimes having a solid skincare routine just isn’t enough to keep us looking as refreshed and rejuvenated as we feel. If you’ve tried every serum and eye cream under the sun to improve the appearance of dark circles, puffiness, and under eye bags to no avail, it may be worthwhile to consider having a noninvasive cosmetic treatment with an experienced and knowledgeable board-certified dermatologist, like Dr. Michele Green in New York. Cosmetic dermatology has many new solutions to treat tired looking under eyes that don’t involve plastic surgery, or downtime at all. These new non-invasive treatments make facial rejuvenation easier than ever. If you are unhappy with dark circles, or under eye hollows, the wrinkles around the eye area, or other areas of the face, it’s time to consult with Dr. Green in NYC to develop a customized treatment plan that caters to your unique concerns and goals to achieve the best results?

Dark circles, puffiness, and under eye bags might develop for a number of reasons. Whether they are genetic or appear as a result of sun damage, eye bags or wrinkles around the eyes can make us appear tired or prematurely aged. A tear trough is characterized by a deep crease that sits between the upper cheek and the lower eyelid, casting a shadow beneath the eyes. Unfortunately, there is no miracle serum or eye cream that can be counted on to improve the appearance of tear troughs. However, a quick and painless treatment with cosmetic dermal fillers in the tear trough area can provide the volume needed to erase the shadow underneath the eyes and result in a revitalized, rejuvenated, more youthful appearance.

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 sun damage, fine lines and wrinkles, hyperpigmentation, acne and acne scars. When you work with Dr. Green to treat your under eye area, you can trust that you have a provider with the skill and knowledge to provide you with the most phenomenal, natural looking, long-lasting cosmetic results. Dr. Green skillfully joins the science of dermatology and the art of aesthetics to enhance the natural beauty of her patients and help them to look and feel like their absolute best.

What causes dark circles?

Dark circles underneath the eyes might appear for a number of reasons. Some of the factors that contribute to the presence of dark under eye circles include fatigue, sun damage, eye strain, dehydration, allergies, genetics, and age. These conditions can lead to the blood vessels underneath the eyes widening and cause the skin itself to become thinner and paler. This ultimately results in the blood vessels becoming more visible, creating the appearance of a darkened under eye area. The efficacy of a specific treatment is completely dependent upon the underlying reason for the dark under eye circles.

Some individuals have a facial anatomy that consists of a crease between the upper cheek and the lower eye lid region. This crease is called a tear trough. Tear troughs can cast a shadow that creates the appearance of a darkened under eye area, making one look tired or prematurely aged. A tear trough deformity such as this can be corrected with a simple, minimally invasive cosmetic treatment utilizing dermal fillers. Even if the dark under eye circles are unrelated to the presence of a tear trough deformity, Dr. Green is here to help. In her office, cosmetic treatments such as Mesopeels, microneedling with PRP and Vbeam laser are often used to correct the appearance of dark under eye circles, puffiness and eye bags. When you work with Dr. Green, she will help determine which unique combination of specially formulated skincare products and targeted in-office treatments will remedy your tired looking under eyes.

What is the goal of tear trough fillers?

The goal of treatment with tear trough fillers is to provide volume to the crease in the under eye area that casts a shadow and leads to the appearance of dark circles and under eye bags. Tear troughs can be genetic, but they may also present as a result of the natural loss of collagen that occurs as we age. The loss of collagen in the under eye area leads to thin and transparent skin, which allows for increased visibility of underlying blood vessels, in turn creating the appearance of a darkened under eye area. 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 to the treatment area, and can be injected into the tear trough area in order to reduce the appearance of dark under 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 aid collagen production, creating 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.

Before and after 1 syringe of Restylane in Tear Troughs (under eyes)

What is the procedure for having under eye fillers?

The first step involved with having any cosmetic treatment is to consult with Dr. Michele Green in her office located in the Upper East Side of Manhattan. During your consultation, Dr. Green will discuss with you regarding your medical history, prior cosmetic treatments you may have undergone, and your cosmetic goals. Dr. Green will also evaluate the targeted treatment area, the skin’s elasticity, and determine the appropriate dermal filler products and the number of syringes required to produce the best results. Depending on preference and time allowance, the treatment for under eye fillers may be performed on the day of the consultation or scheduled for a later date.

On the day of treatment with tear trough fillers, a local anesthetic should be generously applied to the entire treatment area one hour prior to performing any injections. By using a topical numbing cream, it is ensured that the procedure is as comfortable as possible for the patient. Additionally, the dermal filler that Dr. Green uses for the under eye area is compounded with lidocaine that is inside the syringe of filler itself, helping to guarantee that the procedure is as painless as possible.

The numbing cream is cleaned from the treatment area and the skin is sterilized using isopropyl alcohol. Afterwards, the next step is to have photographs taken areas which are to be treated to keep in your private records and written treatment plan. Dr. Green recommends ceasing the use of any blood thinning medications for two weeks before having treatment with dermal fillers, especially for the tear trough area. Both blood thinners and herbal supplements may increase the chances of developing bruising in the injected area and should be avoided before an upcoming appointment for dermal fillers.

Dr. Green will inject the dermal fillers directly into the skin in tiny amounts, using an ultrafine needle. Some injectors prefer to use a cannula rather than a needle, however, by using an ultrafine needle to inject the filler, patients will experience minimal discomfort and observe superior results. Dr. Green utilizes hyaluronic acid dermal fillers to treat the tear troughs. Since hyaluronic acid is a substance that the body produces naturally, the risk of experiencing any side effects is minute. The most common side effects include temporary redness and mild swelling at or near the injection sites. Ice is applied to the treatment area immediately upon completion of the procedure in order to help prevent any swelling that may occur.

To help patients realize their cosmetic goals, Dr. Green will often layer or combine dermal filler products with other cosmetic injectables, such as Botox, during the same visit. In addition to dermal fillers, chemical peels or laser treatments may be used to complete the under eye area rejuvenation process. This combination approach to treatment is dependent on the needs and goals of each individual patient, although most patients elect to combine treatment methods in order to achieve a fully rejuvenated, youthful appearance.

The results of your dermal filler treatment should be visible almost immediately, although they may be disguised by a mild amount of swelling at first. Hyaluronic acid injections dissolve slowly over time, and the results from a single treatment generally tend to last anywhere between 6 to 9 months. The total duration of time for which your results are visible may vary depending on the total number of syringes used during treatment and the number of areas that are injected. After initial treatment with dermal fillers for correction of tear troughs, Dr. Green will see you for a two week follow up to ensure that treatment was satisfactory and determine as to whether any touch up of the hyaluronic acid dermal filler is needed.

Which dermal fillers are used for tear trough rejuvenation?

Restylane dermal fillers are often used by Dr. Green to effectively improve the look of under eye hollows and under eye bags. If your under eye area is tired looking due to age-related volume loss or the presence of small pockets of fat in the tear trough area, using Restylane dermal filler in the area will reduce their appearance. Restylane® can also smooth out any fine lines and wrinkles present in the treatment area and be used to achieve a natural, youthful, beautiful look.

Belotero® Balance is a hyaluronic acid filler that is flexible and thin, making it an incredibly effective dermal filler for treating the sensitive under eye area. The formulation of Belotero eliminates the risk of having the side effect known as the Tyndall effect. The Tyndall effect is the term for the appearance of a blue tint to the skin in a treatment area after having filler. The Tyndall effect occurs when light is reflected off of the particles suspended in the gel filler. When a dermal filler is injected too superficially, when a treatment area is overfilled, or when the skin in the treatment area is very thin, then the Tyndall effect may develop. The Tyndall effect can be corrected by injecting a filler dissolver, hyaluronidase, into the area.

Belotero, however, was designed with the purpose of eliminating the risk of the Tyndall effect. Due to the fact that there are no suspended particles in the gel, Belotero does not have the potential to cause skin in the treatment area to have a blue hue. The result of having the delicate under eyes treated with Belotero injections is smoother skin and a younger looking complexion, without concern for dark circles or hollowed appearance under eyes.

The perfect dermal filler for treatment of your tear troughs and under eye concerns is dependent on your facial anatomy and your cosmetic goals. The best way to determine which dermal filler product is most appropriate for you is by having a consultation with Dr. Green.

18-24 year old woman treated with AquaGold (2 treatments) & 1 syringe of Restylane to tear troughs, 1 syringe Restylane to lips

What are the benefits of nonsurgical facial rejuvenation?

Patients that are in pursuit of a more youthful appearance appreciate the fact that there are cosmetic treatment methods for facial rejuvenation available that provide them with final results comparable to plastic surgery, without the discomfort or downtime associated. There are fewer risks and complications involved with a nonsurgical approach to facial rejuvenation, and having treatment with dermal fillers won’t leave behind any visible scarring, incisions, or stitches. Discuss your aesthetic goals with Dr. Green to establish a plan for facial rejuvenation that caters to your needs.

What are the side effects of under eye fillers?

There typically are not any major side effects associated with receiving under eye fillers, though it is possible to develop a mild amount of swelling or bruising at or around the sites of injection.

Bruising is another potential side effect as a result of bruising.  After the bruising starts to improve, the area can appear discolored for a period of time. This is a temporary side effect and Dr. Green recommends using a good cover-up or makeup, along with good skin care products, to conceal the area until it resolves. It is important to use sunscreens daily after dermal fillers to help protect against this hyperpigmentation and to avoid increased sun damage and wrinkle formation.

Tyndall Effect is a bluish discoloration known to happen after some hyaluronic acid fillers injected. If the hyaluronic acid filler is injected too superficially, the injection area can appear blue. This color change can last several months in the treated area and can be reversed with hyaluronidase to dissolve the dermal filler.

Swelling and Redness are common side effects at the site of injection.  Icing the treated area immediately after your injections, minimizes this reaction.

Some rare but more serious side effects can occur including changes in vision, signs of infection at injection sites, allergic reaction to the dermal filler product, worsening bruising or swelling, and persistent pain. Should you experience any of these side effects, alert your provider immediately.

Who is a good candidate for tear trough filler?

The best candidate for injectable fillers in the tear trough is a heathy individual who has noted volume loss in the under eye area. The skin under the eyes should be taught. Excessive skin elasticity or fat deposits under the eyes would preclude a good cosmetic results. If there is excessive wrinkling or skin under the eyes with fat deposition, a conventional blepharoplasty would be the best course of treatment. During a consultation with Dr. Green, a physical evaluation of the treatment area will be done to determine as to whether you are a good candidate for tear trough fillers or may benefit more from another cosmetic procedure.

When is under eye filler not effective?

Hyaluronic acid fillers, or HA fillers, are not effective for the treatment of naturally darker skin pigmentation in the under eye area. If the appearance of dark under eye circles is unrelated to the anatomy of the tear trough itself, and is due to skin pigmentation, having treatment with dermal fillers in the area will only emphasize the appearance of the dark circles. In these cases, Dr. Michele Green recommends Mesopeel® to rejuvenate the delicate under eye area. The Mesopeel is a specially formulated chemical peel designed to treat the sensitive areas of the body such as the axillae, groin, and the under eye area.

A Mesopeel is able to remove under eye discoloration by removing the dead skin cells of the top layer of the skin, the epidermis, revealing healthy new skin, through rejuvenating ingredients. The Mesopeel Periocular is a very popular in-office treatment, at Dr. Green’s Upper East Side office, to treat under-eye circles and wrinkles in the eye area. The Mesopeel  is composed of azelaic acid, citric acid, lactic acid, physic acid, resorcinol, and salicylic acid. These ingredients work synergistically to reduce fine lines and wrinkles, hyperpigmentation, and discoloration around the upper and under eye area. The Mesopeel Periocular treatment is a non-invasive chemical peel which requires no downtime, and results in all-over eye rejuvenation and is safe to treat patients with all skin tones.

Under eye filler versus blepharoplasty

Blepharoplasty is a type of plastic surgery that improves the appearance of the upper or lower eyelids. Excess skin, droopy eyelids, under eye bags, puffiness, and dark circles can all be corrected with blepharoplasty. Consult with a board-certified plastic surgeon prior to having any treatment for altering the eye area. Expectations, side effects, and risks should always be discussed before electing to undergo any elective cosmetic plastic surgery. Many patients choose to undergo a facelift at the same time that they have a blepharoplasty to achieve total facial rejuvenation.

If you are in need of a refreshed look, but don’t want the downtime or risk associated with plastic surgery, dermal fillers may be the treatment option for you. Both procedures, blepharoplasty and dermal filler treatment, will effectively revitalize the under eye area and result in a more youthful appearance. Tear trough filler treatment is beneficial for those who want to see immediate results, don’t want any downtime, and understand that fillers are not a permanent solution. Blepharoplasty may be ideal for someone who doesn’t mind the downtime, has an excessive amount of skin laxity, little skin elasticity, and who wants permanent results. By discussing your cosmetic goals with a dermatologist like Dr. Green or a plastic surgeon, you can best determine which procedure is suited to your needs.

43 male restylane 1 syringe 4w MGWatermark

Restylane – 1 syringe, 4 weeks

Can you reverse tear trough filler treatment?

The types of fillers that are used to correct the appearance of eye hollows and eye bags and to rejuvenate the tear trough area are composed of hyaluronic acid gel. Should you receive treatment that you aren’t satisfied or comfortable with, your injector can reverse the effects of the filler treatment using a product called hyaluronidase. Hyaluronidase injections can be used to dissolve any unwanted facial filler product that is made of hyaluronic acid.

Dr. Michele Green has utilized hyaluronidase to correct the appearance of poorly placed or inappropriately injected hyaluronic acid filler that patients had performed elsewhere, typically with an inexperienced injector. Reducing unwanted side effects such as puffiness underneath the lower eyelid and tear trough area is completely possible with hyaluronidase injections.

Which complementary treatments can be performed with tear trough fillers for facial rejuvenation?

Botox is one of the most popular cosmetic treatments done in the United States because of its outstanding ability to soften the appearance of fine lines and wrinkles, including around the eyes. Botox is popularly used to treat the outer canthal lines (crow’s feet) that tend to appear as a result of smiling, squinting, and other repeated expressive movements. Natural, beautiful results can easily be achieved when treating crow’s feet with Botox by injecting the orbicularis-oculi muscle. This is the ring-shaped muscle surrounding the eye that, when injected with Botox, relaxes- softening the appearance of wrinkles or helping to prevent them from forming in the first place! Dr. Green often treats patients for tear troughs and crow’s feet in the same visit, using dermal filler and Botox respectively, to achieve total rejuvenation of the eye area.

Total facial rejuvenation is now achievable without plastic surgery, all thanks to dermal fillers. Not only are fillers used for the tear trough area, but by using cosmetic injectables such as Juvederm®, Sculptra®, Belotero®, and Restylane®, Dr. Green is able to replace lost volume in areas of the face such as the cheeks, chin, jawlines, temples, and nasolabial folds. It is also possible to smooth out fine lines and wrinkles and plump up the lips in order to restore and rejuvenate the entire face. With dermal fillers, you are able to achieve a natural looking, more youthful appearance, without plastic surgery, and no recovery time involved.

Under eye dark circles and wrinkles can be improved through microneedling. Microneedling® is done with a tool called a Micropen (or Dermapen) that has tiny surgical-grade needles embedded in the tip. These needles are used 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. To treat the delicate and sensitive skin around the under eyes, Dr. Green performs treatment at a more shallow depth than what is typically used for the rest of the face.

The effects of microneedling can be further enhanced by combining the treatment with Platelet Rich Plasma (PRP). PRP employs the cytokines and growth factors in plasma, derived from a sample of the patients own blood, to boost the effects of microneedling. The PRP is able to penetrate the skin more readily through the newly created micro-channels made by microneedles, helping to speed up the healing process and promote even more regeneration at the cellular level to rejuvenate your skin.

To determine which combination of cosmetic treatments is most appropriate for you, it’s best to first have a consultation with a board-certified expert in dermatology, like Dr. Michele Green. Dr. Green takes a holistic approach to customizing each of her patients treatment plans to achieve the best results. During a consultation, your medical history will be discussed in depth and an individualized plan established to address your unique skin concerns.

What is tear trough filler?

Dermal fillers that are used for treatment of the tear trough area should ideally be composed of a hyaluronic acid gel. Hyaluronic acid is a naturally occurring substance that is already produced by the body. Hyaluronic acid fillers are gel-like substances that are soft in texture and are often used to replace lost volume and reduce lines and deep wrinkles. Hyaluronic acid binds to water when injected, softening and hydrating the skin to produce a more youthful appearance.

After 2010, the FDA approved hyaluronic acid fillers compounded with lidocaine to make these dermal injections more comfortable for patients. Hyaluronic acid has the unique ability to plump and hydrate the skin. Hyaluronic acid injectable treatments are believed to have long-lasting effects. There have been recent studies which show that repeated injections of hyaluronic acid fillers stimulate the body to produce its own collagen. Over time, with the new collagen that is produced, there may be less dermal filler needed to achieve the same cosmetic effect.

How long do tear trough fillers last?

Dermal filler typically tend to last for anywhere from six months to two years. The rate of absorption of a dermal filler varies for each patient depending on their metabolism and the location the filler was injected. Areas that are subject to a lot of repetitive movement and used for facial expressions tend to metabolize filler more quickly. Since the under eye area doesn’t have a lot of mobility, hyaluronic acid filler is not metabolized as quickly when injected in the tear trough as when injected in the cheeks or the lips.

wedding botox shutterstock 678404389

How much is filler for tear troughs?

The total cost of your tear trough filler treatment will be dependent on a number of factors. An experienced board certified dermatologist, who is an expert injector, like Dr. Michele Green, will be more expensive than an injector at a medspa.  Although it will be more costly to have the procedure done by a more experienced injector, it is important to be very selective when making the decision to ensure that unwanted side effects are avoided such as the Tyndall effect or uneven filler placement. One should never have dermal filler injections with a provider who is not a board-certified dermatologist or plastic surgeon.

Other factors that play into the total cost of your treatment include the geographic location of the office in which you are treated, the type of dermal filler product used to treat the tear trough area, and the total number of syringes of filler used to achieve your final results. During your consultation with Dr. Green, you will have the opportunity to discuss your cosmetic concerns and goals. Then it will be determined which dermal filler products and the total number of syringes required to provide you with the best cosmetic results, and at that time, the total cost of treatment will be specified.

Are tear trough fillers safe?

Dermal fillers are approved by the FDA for use in the midface, cheeks, nasolabial folds, nasojugal grooves, and lips. Although the use of tear trough fillers has not yet been approved by the FDA, the treatment is entirely safe so long as it is performed by a board-certified expert in dermatology, like Dr. Green. It can be potentially dangerous to have tear trough filler injections done by an inexperienced or unqualified injector.  By choosing to have tear trough filler treatment with an expert cosmetic injector, you will have someone with experience and knowledge of facial anatomy provide your care.

Does treatment with tear trough fillers hurt?

A local anesthetic is applied to the treatment area one hour prior to performing cosmetic injections in order to minimize patient discomfort. In addition, the dermal filler itself is compounded with lidocaine, making the process essentially painless for the patient.

How long does tear trough filler take to settle?

It can take up to two weeks for the dermal filler to settle in the treatment area and for final results to be observed. Dr. Green likes to schedule a two week follow up appointment for her patients who have tear trough fillers in order to evaluate the treatment and determine if any touch up is required after the filler has fully settled.

How to get started with tear trough fillers today

In her boutique Upper East Side NYC dermatology office, Dr. Michele Green treats men and women alike for tear trough deformities, skin laxity, fine lines, wrinkles, hyperpigmentation, sun damage, and many other areas of cosmetic concern. If you are unhappy with dark circles under your eyes, or under eye hollows, correction with hyaluronic acid fillers, lasers, or chemical peels may be the best treatments for you. With other 25 years of experience in cosmetic dermatology, Botox, Restylane and Juvederm injections, chemical peels, Thermage®, and Fraxel® lasers, Dr. Green will help design the best non-invasive cosmetic treatment for you, without the need for plastic surgery.

Dr. Green is consistently voted as one of the best dermatologists in New York by Castle Connolly, New York Magazine, Super Doctors, and the New York Times. She is an expert cosmetic injector and is here to help you restore a more youthful appearance and minimize dark under eye circles, puffiness, and under eye bags. Please contact us online today or call 212-535-3088 to begin your cosmetic rejuvenation process today.

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