Video Blog: Tear Trough Augmentation

Check out my video blog on YouTube: 

One of my favorite procedures to do since the introduction of Belotero Balance in the United States last October.

The tear trough is a grooved demarcation where the cheek skin meets the much thinner and highly vascular eye skin.  Because of the anatomy of this area, a thinner hyaluronic acid like Belotero is the perfect product (Belotero: The Buzz.).  It does not last as long as the more viscous hyaluronic acids, but it also has fewer complications.

Treatments in the middle third of the face, which contains the eyes, nose, and cheeks, require an aesthetic eye and advanced knowledge of facial anatomy.  Filling the tear trough area often requires cheek augmentation as well in order to look natural.  The cheeks can require a large amount of product depending on the degree of volume depletion.  Make sure you discuss this with your injector prior to injections!

This is a very advanced procedure, make sure you check out before and after pictures before being injected!  Many practioners do not offer this procedure because of the advanced training and skill it requires.  When done correctly, it looks AMAZING.  I’m not even a very good iPhone photographer, and I have some great before and after’s on my Pinterest and in other blog posts:

More Belotero!.

I hope you enjoyed my video.  They are really hard to make!

More Belotero!

Belotero: The Buzz.

Belotero has been my #1 selling injectable since it has been on the market (September). It gets into the small little lines that no other product really can with the natural result that Belotero offers.

The procedure I do the most? Under the eyes! It literally takes 10 years off your face! I might not be able to take away sleepless nights and stress, but at least I can make it look like I did by improving Under Eye Circles and Bags! I’m so thrilled with this product I did my own under eyes (called the tear trough). December was so busy and stressful, I was looking really tired. I did my under eyes about a year ago with Juvéderm, but Belotero is much better designed product for this area (read why below).

Do you see how tired I look? (I hate sharing before pictures of myself with no makeup!)

A little numbing cream is put under the eye for about 20 minutes. Then the numbing cream is removed and the face is marked for anatomical landmarks. This is just how I mark the face. Other injectors might do it differently. I am also aware I need an eyelash fill REAL bad.

Looks so much better after!!! It didn’t bruise or hurt at all!

Look at my dark circles. They are TOTALLY gone. I swear I have NO advanced computer knowledge what-so-ever. These are straight off my phone!

Belotero vs. Juvéderm vs. Restylane

Why do I like Belotero under the eyes more than other Hyaluronic Acid (HA) products? Belo doesn’t have any hydrophilic effects (hydrophilic = attracts water molecules). Plus or minus a little bit of swelling, the correction looks the same the next day, the next week, and the next month.

Juvéderm and Restylane are also in the HA family, but have a hydrophilic effect. This means the product will take on water molecules after it is injected, giving the area treated more correction over the next few days to weeks. Great for your lips and cheeks. Not great in the ultra thin skin under the eye. When this area is over treated you will see a bump or a bluish hue from the product. It’s not pretty. But it can be dissolved!  Hyaluronidase; Just In Case: injectables for beginners..

I also like Belotero because the product is thinner, which means it can be deposited in more superficial areas with a smaller needle and less pokes! Yay!

**Remember though: It’s the right product for the right place for the right person! Discuss which product is right for you and why during a consultation!  For more general information on which product is right for you What Goes Where?

More Before and After Pictures

The above patient had 0.2cc of Belotero to her tear trough area. It was two injections. The patient stated she did not even feel it (topical numbing cream was used prior to injection). The patient experienced no bruising associated with the procedure.

The above patient is a good candidate for filler in this area because the dark circles under her eyes are accentuated by a shadowing effect from volume loss. By replacing volume, the skin of the eye and cheek become more continuous as opposed to separate.

The above patient had 0.3cc of Belotero to her tear trough area. Topical numbing cream was used prior to injection, and there was no pain associated with the treatment. The patient experienced minor bruising the day after the injection which was easily covered with make-up.

The above patient would be a good candidate for a blepharoplasty. Although there is a clear demarcation of her tear trough, and filler drastically improved the area, the root cause of the delineation is not so much volume loss as it is a herniated fat pad. This fat pad is supposed to cushion the eye as it sits in the eye socket. Numerous causes contribute to the pad “bulging” out.

Interested in learning more about blephs?  Read Why I Chose To Have an Eyelid Lift.

The above patient had 1cc (1 syringe) of Belotero to her superficial marionette lines with great improvement to the texture of her skin. Topical numbing cream was used. The patient did experience some minimal bruising the day after the procedure. She is very happy with the outcome.

XOXO, LK

Above picture:

2 months after my Belotero treatment

3 days into the annual Cutera Conference in Las Vegas (so, I haven’t slept in 3 days)

1 week post break-up with my boyfriend

And still looking refreshed! Thanks Belo! Qué Bella!
(that’s Spanish I think…)

Under Eye Circles and Bags

Physiology: Broken blood vessels within the lower eyelid. A shadow forms underneath the bag causing the dark circles to appear. As you age, the “bags” (fat pads) can bulge due to gravity, creating an exaggerated space between the skin of the check, and the skin of the eye, over the orbital rim (bone of the eye socket). These dark circles can bring about a chronically fatigued look, or make you appear older than you actually are.

Cause: range from fatigue, vitamin deficiency, hyperpigmentation, allergies, age, and medical conditions. However, heredity is the most common cause for bags under the eye (also, from my patient’s personal experience… I hear children and husbands may also be contributors? It has not been clinically proven however.).

Treatment:

Getting the proper rest and eating the right foods can sometimes help treat and improve dark under eye circles, but if genetic, dark under eye circle will increase if untreated.

Fraxel®, Thermage®, Blue Light Therapy, IPL Photofacial, Dermal Fillers and Chemical Peels (like TCA). Patients with more severe cases of under eye circles, puffiness and loose upper or lower eyelids may want to seek out surgical alternatives including blepheroplasty.

My Best Advice

It is always a good idea to start with the least invasive methods and move on to the most invasive methods. That being said, genetics does play a HUGE role in this, and if your mom or dad has extremely sagging lids, or bulging fat pads, the earlier you do surgery the best result you will have.

Least Invasive to Most Invasive

1. Hydration: The area of skin under the eye is the thinnest in the body. In a hospital setting, we monitor this area as a sign that a patient could be dehydrated. I can always tell when someone needs fluids just by looking at this clinical sign. Start with drinking water… water is good for your body all around. And… it’s FREE!
   
2. Eye Cream: Supply your skin with the nutrients it needs. By depositing certain vitamins and peptides, you can decrease the appearance of dark circles. Before you tell me you’ve tried every cream under the sun… have you read my post on pharmaceutical products? Step 2: Spend wisely.
3. Noninvasive treatments: Laser stuff. Not my area of expertise, however, I have had IPL on melasma, and it worked great. Laser treatments will help with the discoloration, and may subtly tighten the skin, but they will not fill volume loss. If you have volume loss, see step 5.
4. Chemical Peels:  Best done in the winter time when you’re not in the sun.  And actually… this is more for fine lines and wrinkles around the eyes than bags and dark circles.  Although it will help the appearance.
   
5. Dermal Fillers : (That’s NOT Botox..) A hyaluronic acid of low molecular cross linking like Juvéderm Ultra is most recommended for this area. Thicker fillers, like Radiesse, and biostimulators, like Sculptra, are not recommended for this area. Remember this skin is the thinnest in your body, and thicker products can leave bumps here. Be VERY careful about who you see for this treatment. It is a very advanced procedure that your Dentist or Primary Care probably shouldn’t be performing on you.
   
6. Blepheroplasty: Check out my post on Blephs. Observing Surgery: Blepharoplasty.

Dermal Fillers

Dermal Fillers are my area of expertise (Remember photography is also not my thing!!!)

Here’s my Before and After Tear Troughs:

Before: I look tired. And old. Ew. Taken November 2011.

After: As you can see I look more awake and refreshed. Taken February 2011 after I had my tear troughs filled.

I am very happy I did this. Surprisingly, it didn’t hurt at all. The product used was Juvéderm Ultra. It will last about a year. Cost is about $600.

Creams

(The two I like best)

Image Max Eye Cream: This next-generation revolutionary day and night eye crème contains high concentrations of growth-factors derived from plant stem cells to protect skin cells and prevent aging effects caused by free radical damage. Reduces the appearance of fine lines and wrinkles; reduces puffiness and inflammation. Prevents cell aging. Contains grape, alpine edelweiss and apple stem cells for maximum age prevention. Corrective peptide blend for rejuvenation. Retails for about $45

Image Vital C: A scientifically- advanced hydrating, anti-aging eye gel. Contains a blend of nourishing anti-oxidants that reduce the appearance of fine lines and prevent the breakdown of collagen. Vitamin K  (Phytonadion) diminishes dark circles. Restores youthful looking eyes. Retails $31