Tear Trough Treatment

tear troughs 1

BEFORE

tear troughs 2

AFTER

Are you bothered by dark circles under your eyes?  This is a common complaint from patients and the good news is, you can do something about it!

If volume loss in the tear troughs is a contributing factor to the darkness you are perceiving, a dermal filler can help to replace the lost volume.  The above patient received 1 ml of Juvederm® Vollure, a half syringe per side.  The amount of filler in this area varies depending on the amount of volume loss.  Less can be more as an overfilled tear trough can have an aesthetically unnatural appearance.   I utilized a cannula for this treatment to minimize bruising and risk of intravascular product placement.  The product was placed below the muscle.  A small amount of product was put in the upper medial cheek as well to create a buttress of support.  Frequently, as we age, the tear trough extends in to the cheek (nasojugal groove) which can also be corrected with the filler.

In this case,  the patient left the office with two tiny dots on her cheeks where a needle was used to create an entry point for the cannula. (full disclosure, even with a cannula there can be bruising)  Otherwise, she was thrilled and felt she looked rested and rejuvenated after an easy 30 minute appointment!

There are scenarios in which the shadowing is due to the pigment in the skin as well as volume loss in this area.  In those cases topical products can help lighten the skin slightly.  Darkness under the eyes can be difficult to address due to the fact that the tissues here are quite a bit thinner than other areas of the face.  Right under these tissues is muscle, which is slightly blue, and this can show through these thinner tissues.  Vascular bodies in this area can also create shadowing.  You can evaluate with your provider what can be addressed and what realistic expectations would be in your situation.

If you opt for filler under the eyes avoid medications and supplements that may thin your blood for 1-2 weeks before your appointment. (ibuprofen, aleve,  aspirin, fish oil, vitamin E, etc)  We use HA fillers only for tear trough volume as it has the highest safety profile for this area.  HA (hyaluronic acid) can be dissolved if needed with an enzyme.

Lastly, the good news is,  we find filler lasts quite a while in the tear troughs compared to other areas of the face.  I have had patients who still look corrected at two years.

 

 

 

 

RESTORING YOUR LIPS

When assessing and treating a patients lips there are several subtle changes that can rejuvenate the mouth area without making the lips look “done”.  Although some patients want much fuller lips, a lot of us prefer subtle changes.

old lips

young lips

lip comparision

As we age our upper lip changes in several ways.  We tend to lose the definition along the vermillion border, the philtral ridge/columns (the vertical columns that start at the tip of the cupids bow and end below the nose) flatten and the space between the upper lip and nose elongates.  Subtle changes can be created with easy injection techniques, including defining the vermillion border, restoring the philtral columns and accentuating the cupids bow.  Restoring the philtral columns frequently make the lip lift slightly.  Filling these columns can return the contours that were likely once there.  Vertical lip lines can be softened as well.  Small amounts of filler can be placed within the lip itself to restore lost volume.  There are many fillers to choose from these days,  giving the patient and provider options, depending on the treatment plan.  Fillers vary in their hyaluronic acid %, viscosity, elasticity and cohesiveness.

When assessing and treating the lower lip there are several changes that can have a nice impact,  other than just looking fuller.  Again, the vermillion border can be defined and fine lines can be corrected.  The oral commissures, which tend to turn down as we age, can be turned back up with filler placement techniques.  Volume restoration can be completed to obtain the desired effect.

The ideal balance of upper lip to lower lip is 1/2 to 2/3’s.  This does vary individually and you and your provider can decide the best proportions for you.

In addition to fillers, small doses of Botox® or Dysport® can be utilized to relax muscles in this region of the face.  If a person tends to purse their lips  Botox® or Dysport® can be used in the muscle surrounding the mouth (the orbicularis oris) to minimize the pursing.  This injection technique also tends to roll the upper lip up and out slightly, making it appear slightly fuller.  Additionally, for a gummy smile,  an injection a little higher (closer to the nose) in the upper lip can relax the muscle that lifts the lip up.  This injection prevents as much gum tissue from being exposed with animation.

Another placement of Botox® or Dysport® that can help in the lower face and lip area is treating the depressor anguli oris ,(DAO) which, in some individuals, pulls down the sides of the mouth.  Very small doses are utilized in these muscles to help minimize the appearance of frowning.

As with all facial injections, make sure your provider has a thorough understanding of facial anatomy.   Ask if there is an “emergency kit” for injectables in the clinic.  (a kit containing an enzyme to dissolve filler, should it be required)

Do not worry that having injectables in the mouth area will leave you with unnaturally big lips. (which we have all seen) If you and your provider are on the same page, you can obtain a natural restoration of the volume and definition you once had.