Tear trough hollowness: is Restylane used for the under eye hollowness when the patient had a subtractive lower bleph?

Dr. Dean Kane Q & A botox Q. Tear trough hollowness: is Restylane used for the under eye hollowness when the patient had a subtractive lower bleph? 20 years have passed since a surgeon performed a lower bleph (subtractive) in an effort to remove under eye “darkness.” Are there plastic surgeons who specialize in fat replacement in the tear trough area? I have had some Navy doctors who played “experiments in cosmetic surgery” 20 years ago so I don’t want to fiddle around. Any cosmetic surgeons who can defeat this hollowness in either Texas or in Virgina/North Carolina area? Thanks! A. The lure of a visible scar from a traditional lower lid blepharoplasty scares away many a patient. Many proceed to a trans-conjunctival blepharoplasty (TCB) which removes the fat bags but does nothing to rejuvenate the lower eyelid skin looseness, the tear trough nor any cheek descent. ​ Options for this hollowness, as you describe include:
  1. filler in the deep medial and lateral fat compartments of the anterior cheek (ie the “apple” of the cheek, filler under the zygomaticus muscles to lift the nasolabial fold and cheek mound; all using a projecting hyaluronic acid (HA) filler such as Voluma or Lyft.
  2. further layered HA filler such as Juvederm Ultra Plus or Restylane in the more superficial subcutaneous layer under the orbicularis muscle and along the tear trough
  3. if you are a candidate and you did have a TCB, consider a modified traditional blepharoplasty (no more fat removal) with possible mid-face lift (to elevate the soft tissues of the cheek and close the tear trough separation) with muscle suspension or canthopexy.
These are all advanced techniques of injection or surgery and should be thoroughly evaluated by a well experienced, Board Certified Plastic Surgeon or ENT Facial surgeon. I hope this is helpful. All the best!
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