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Restylane for Rested Eyes: tear trough injections for improving dark circles and under-eye puffiness

I got my tear troughs done Wednesday!

Translation for those not in the tear trough know: I had Restylane injected into the area underneath my eye. And when I woke up in the morning and looked in the mirror it was like the gates of heaven opening up, rays of sunshine pouring down, and the angels singing down at me.

If you caught my last blog, you know I’ve had dark circles under my eyes my whole life. It’s always disconcerting to see a child with dark circles under her eyes. Whenever I see that, I can’t help but think, Is that child sleeping at all? Is her mother not feeding her properly?! But, of course, lots of people have under eye issues (like dark circles or bags) for many reasons other than lack of sleep!

Let me back up first. What’s a tear trough? The first time I heard about injecting filler into a tear trough I thought: Holy crap! Where the heck are they sticking that needle? In your tear hole? What’s a tear trough?! The tear trough (in medical language: nasojugal groove) extends from the inner corner of the eye, making an arc shape, and continuing on to the outer corner of the eye. It’s basically the crecent-shaped area under your eye.

So why do we see those dark circles or hollowness or bags under our eyes…especially as we get older? Apparently the most common factor is heredity. Yep. Thanks mom. Often, dark circles are caused by volume loss in the under eye area. As we lose collagen in our skin from age and sun damage, our skin appears thinner, begins to sag, and has less of the volume we see in younger skin. That volume loss allows the orbital bone, which is just under the tear trough and sits at the top of the cheek, to show more, and this creates the hollow trough that appears as a dark circle. The hollowness can also create a shadow that contributes to darkness under the eye.

The eye area also has extremely thin skin, and so it is one of the first areas on the face to show aging. Dilated blood vessels that sit close to the thin under-eye skin are another cause of dark circles. Environmental allergens, which cause blood to pool underneath the skin, can worsen the appearance of dark circles. Lack of sleep can be a factor. And lastly, sun damage can make dark circles worse. Sigh. All my blogs seem to have one thing in common…the inevitability of changing and aging skin.

So, is everyone a good candidate for tear trough injections? There are some more perfect candidates, of which I am not! It is ideal to have good skin elasticity and thicker skin. I really don’t have either…heredity again. But an experienced injector, like our Aesthetic Filler Injector expert Iris Taylor, can employ techniques to help you achieve the look you desire, even if you have are not the ideal candidate for this procedure.

What kind of filler should be used for this procedure? Restylane and Juvederm are most commonly used under the eyes, but Restylane seems to be the safest and most ideal filler for filling this area. Restylane has a long track record of safety around the eye and does not spread around like Juvederm does, which is good for this particular procedure. Also, Juvederm can create too much of a plumping effect under the eyes and therefore looks puffy. Similar and more severe issues can occur with other fillers as well.

In fact, one of our aestheticians, Jenny Allen, had her tear troughs done elsewhere about 3 years ago and they were quite overfilled. The injector used Juvederm and either put too much or placed it too superficially, leaving her looking puffy with bigger under eye bags and giving no improvement to her dark circles. In fact the dark circles had an almost bluish hue to them, which is known as the Tyndall effect. The Tyndall effect is basically the intensity of light scattering and makes the color blue more visible to us. This unwanted dark blue and puffy effect may persist for many years unless corrective measures are taken. Iris corrected Jenny’s tear troughs recently by injecting her with hyaluronidase to dissolve the filler, and then re-filled her tear troughs with Restylane, making them look natural and not over-filled, and giving Jenny the look she originally wanted.

Overall aims for filler injections under the eyes are: to improve wrinkles and add volume to thinning or sagging skin, to create a barrier layer between the blood vessels and the thin skin, to decrease the appearance of bulging under eye fat, or to minimize the appearance of a depression in the tear trough. Iris says the goal should always be to create a natural, smooth transition between the under eye area and the cheek.

Although you may want to have your tear troughs filled for a different reason, I wanted mine done to minimize discoloration and to reduce the look of hollowness at the top of my cheekbone, where the orbital bone was becoming more visible. It looked sort of like an indentation between the bone and the under eye.

As with any procedure involving needles, particularly near my eyeballs, I was a little concerned about pain. I numbed my under eye area with anesthetic cream for about half an hour and decided I would close my eyes during the injections, so as to not see the needle coming towards my eye.

I don’t know about you, but I don’t like anything near my eyes, and even glasses can be a challenge sometimes. I’ve always been so thankful I don’t have to wear contacts because OH MY GOD what could happen if I had to touch my eyeball??! So I worried this might be a problem during the tear trough procedure. But it didn’t bother me at all. The pain was completely minimal. I couldn’t even feel the needle pierce the skin. I could feel some pressure and every once in awhile there would be a small sharp sensation but overall the level of discomfort was minimal. She did multiple injections into the tear trough and massaged the area to smooth the filler. I have very thin skin and minimal fat in the eye area so Iris went slowly and spent time massaging the filler to create a smooth blended appearance. I had a few injection marks directly after the procedure, and to my untrained eye, I couldn’t see much difference directly after, as I looked at myself in the hand-held mirror in the treatment room.

To me, I was looking for a change in the discoloration, but immediately following the procedure, there were some injection marks and what looked like the beginning of some bruising (I ended up not having any bruising). My mascara had also run a little as it mixed with the numbing cream…so I couldn’t see much of an improvement in the coloration. However, I could see an improvement in the hollowness, particularly near the inner corner of my eye, by my nose.

As Iris is a perfectionist, the procedure took about an hour and we only used about half of a syringe. Her recommendation was to reevaluate the results at my follow-up and see if we thought I needed or wanted more filler in the tear trough. I very much appreciate this approach as I’d rather make changes a little more slowly and get the results exactly as I want them, rather than have over-filled tear troughs.

The morning after my procedure is when I saw the dramatic change in my eye appearance. I looked in the mirror and my eyes looked completely improved. What it looks like to me is that I look younger. Or rested. The dark circles are vastly improved and there is added volume. It even seems like the light reflects differently off my eye area now. It's truly amazing to me. Like I said:

Gates of heaven. Sunshine pouring. Angels singing.

Restylane in the tear troughs!!

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