Tear Trough Filler: Which is best?

Tear troughTear troughs are the grooves some people have under their eyes. Unfortunately for most of us, they become more prominent as we age leading to under eye hollows. Filling them, though, is often an excellent way to reduce or eliminate them.

Because under eye skin is thin, there isn’t much room for error, and getting the right tear trough filler is key to success.

Tear Trough Filler Choices

Most injectors use hyaluronic acid fillers. This category of fillers include Juvederm, Restylane, and others. While these dermal fillers share the same active ingredient, they differ from each other in their lifting capacity, water retention, and how they integrate with the skin.

Restylane and Belotero are my preferred fillers.

Out of the two, Restylane is the heavier product and lifts the skin more than Belotero. If the under eye needs lifting, I place Restylane deep and on top of the bone in order to push up the overlying skin. One of the limitations of Restylane is that it cannot be placed too superficially because it can create a blue discoloration.

Belotero is unique in that it integrates seamlessly into surrounding skin. It can be placed high in the skin without creating bumps or discoloration.

I use Belotero when there is more of a need to fill rather than lift. Often times, I use both Restylane and Belotero since many people need both lifting and filling.

Fillers to Avoid

Some fillers are flat out not suitable for the tear troughs. Sculptra is one. The risk of nodule formation is high with this product. I also avoid using Radiesse for the same reason.

I don’t use Juvederm as a tear trough filler either. Juvederm pulls water onto itself. This is great for plumping lips and folds, but creates an unnatural swollen look in the tear trough.


As I mentioned earlier, the skin under the eye is thin. This increases the risk of visible bumps if filler is not injected skillfully.

Also, the under eye area is rich in blood supply, so the risk of bruising is higher than normal. Using cannulas reduces this risk.

Cannulas vs. Needles

Cannulas are blunt tipped needles. They are inserted through the skin via a small needle poke opening and slid under the skin to inject the filler. Surprisingly, the process is actually quite painless.

The main advantages of using cannulas are the decreased risk of bruising and increased level of comfort.

Needles are more precise, and sometimes I choose to use a needle, so I can more precisely place the filler.

Recovery and Results

As with most fillers, swelling may appear and last for a few days. However, it is usually not dramatic, and if there is no bruising, very few people would notice anything unusual.

Under eye fillers last longer than when the same filler is used in other areas, often lasting up to a year.

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