Fillers

Hyaluronic acid filler in the tear troughs can address specific concerns about the interface between the lower eyelid and cheek. It is important to seek not only a fellowship-trained but also a double board-certified facial plastic surgeon to help determine whether placement of hyaluronic acid filler in the tear troughs is an appropriate treatment for your concerns. The tear trough breaks a smooth, youthful transition from the lower eyelid to the cheek A youthful face has a smooth transition from the lower eyelid to the cheek. The tear trough is a line or depression that develops at the border between the lower eyelid and cheek. It worsens as the cheek droops and the lower eyelid bags develop. The tear trough is not a wrinkle but the location of a ligament separating the lower eyelid fat from the cheek fat. The deeper the tear trough the more visible it becomes due to its shadowing effects. Filler is placed precisely in in the tear troughs with a microcannula Hyaluronic acid filler such as Restylane© products can be used to soften the appearance of the tear trough. Restylane© and most Juvederm© brand hyaluronic acid fillers are FDA-approved products but placed in the tear troughs off-label, meaning FDA-approval was not sought specifically for placement of these products in the tear troughs. Currently the only hyaluronic acid filler FDA-approved specifically for placement in the tear troughs is Juvederm© Vollbella© XC and Restylane© Eyelight™. Other products have long been used safely and effectively in this area off-label, though it is important that injectors have a conversation with their patients about this fact. A blunt-tipped microcannula rather than a needle is typically used to deposit the filler at the tear trough precisely, adding enough volume to treat the site without adding so much that the lower eyelids look "puffy." The microcannula may reduce the risk of bruising and swelling as well as the risk that the filler is injected into the wrong location, including a blood vessel. Recently, the media has published multiple articles calling into question the value of placing hyaluronic acid filler in the tear troughs, highlighting some of the rarest and most sensational risks associated with the procedure. This reporting, in my opinion, simply highlights the importance of an appropriately qualified provider administering the material at an appropriate location and depth in an appropriate patient (1). Filler can soften the tear troughs in individuals with appropriate anatomy The best candidates for placing filler in the tear trough often have a deep tear trough without severe lower eyelid bags. One should be cautious placing filler in the eyes with severe lower eyelid bags because it is more likely to make the area look "puffy." Some swelling is expected after treatment, however. The swelling resolves gradually over a few days in most patients. Patients are counseled to apply cold compresses to their lower eyelids and cheeks for the first 48 hours after treatment to accelerate this process. Some individuals are more likely to benefit from lower eyelid surgery (blepharoplasty) Deep tear troughs with lower eyelid bags are usually best treated with lower eyelid surgery (blepharoplasty). A consultation with a fellowship-trained, double board-certified facial plastic surgeon is recommended to determine candidacy for this procedure, because there may be factors that preclude this procedure for certain individuals. A detailed history and physical should always be performed prior to making the decision as to whether hyaluronic acid filler or surgery of the lower eyelids is the most appropriate treatment. Reasonable expectations must be established about what lower eyelid surgery can and cannot accomplish as with all plastic surgery procedures. Trust Your Face to a Facial Plastic Surgeon It is important to seek a fellowship-trained specialist in plastic surgery of the face and neck when you have concerns about age-related changes to your face and/or neck. Why Choose Dr. Harmon The mission of Harmon Facial Plastic Surgery is to help people along their journey towards self-confidence, to feel good about feeling good. Dr. Harmon is a double board-certified facial plastic surgeon. Dr. Harmon values making patients feel welcomed, listened to, and respected. Dr. Harmon graduated with honors from Cornell University with a Bachelor of Science degree in molecular biology. Dr. Harmon earned his medical degree from the University of Cincinnati. Dr. Harmon underwent five years of extensive training in head at neck surgery at the prestigious residency program at the University of Cincinnati. Dr. Harmon then underwent focused fellowship training in cosmetic facial plastic surgery through the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) with the world-renowned surgeon, Dr. Andrew Jacono, on Park Avenue in New York City. Request a Consultation Request a consultation with Dr. Harmon at Harmon Facial Plastic Surgery in Cincinnati. Visit our clinic. You will learn more about Dr. Harmon's credentials, style and approach. Build a relationship with our dedicated team. Do not stop at searching "plastic surgery near me." Get in touch with us today to learn more! Contact Us References Torabi SJ, Massry G, Azizzadeh B. Are Tear Trough Fillers Really that Bad? Facial Plast Surg Aesthet Med. 2024 Dec 12.

Hyaluronic acid dermal fillers can address specific concerns about flatness or poor volume in your face, including your temples, cheeks, tear troughs, lips, chin, and/or jawline. It is important to seek not only a fellowship-trained but also a double board-certified facial plastic surgeon to help determine whether dermal fillers are appropriate for your concerns. Different Hyaluronic Acid Dermal Filler Products Deform and Change Under Stress Differently The study of how a material – in this case, hyaluronic acid dermal filler – deforms and changes under mechanical stress is called rheology (1). Hyaluronic acid is produced in the body in massive quantities but is soon dissolved. In contrast, hyaluronic acid dermal filler products are produced in a laboratory, outside of the human body, with particles of a controlled size, concentration, and extent of crosslinking. Crosslinking is a chemical process that binds these hyaluronic acid particles. It is these qualities that are used to produce dermal filler products with features that are optimized for placement in specific areas of the face to achieve a cosmetic goal. Extent of Crosslinking and Concentration of Hyaluronic Acid Determines Rheology More extensive crosslinking results in a stiffer dermal filler. It also prolongs the effect of the product. A higher gel concentration also results in a stiffer gel. Different products include hyaluronic acid at different concentrations and different levels of crosslinking to produce a desired effect. Rheology Describes Useful Hyaluronic Acid Dermal Filler Qualities The stiffness of a dermal filler, or its ability to return to its original shape when acted on by forces, is called the G'. The higher the G', the stiffer the gel. Each hyaluronic acid product takes a different approach to reach a specific G', with some products focusing more on the extent of the crosslinking while others focusing more on the concentration of hyaluronic acid particles in the gel. For example, softer hyaluronic acid fillers such as Restylane Silk© are often used more superficially or in areas with thinner tissue overlying it, such as the tear troughs, due to its lower G'. In contrast, Restylane Lyft© has a high stiffness, or G'. As a result, it is generally placed deeper and in areas requiring a more pronounced, stable lift, such as the cheeks or temples. The extent of crosslinking and concentration of hyaluronic acid gels also determine the product's cohesivity, which determines whether a product maintains projection or falls apart with pressure, such as massage. A less cohesive product is more malleable and can be massaged in place more easily. Restylane products have the lowest cohesivity of the different brands of hyaluronic acid fillers (2). Trust your face to a facial plastic surgeon It is important to seek a fellowship-trained specialist in plastic surgery of the face and neck when you have concerns about flatness or poor volume in your face, including your temples, cheeks, tear troughs, lips, chin, and/or jawline. Why Choose Dr. Harmon The mission of Harmon Facial Plastic Surgery is to help people along their journey towards self-confidence, to feel good about feeling good. Dr. Harmon is a double board-certified facial plastic surgeon. Dr. Harmon values making patients feel welcomed, listened to, and respected. Dr. Harmon graduated with honors from Cornell University with a Bachelor of Science degree in molecular biology. Dr. Harmon earned his medical degree from the University of Cincinnati. Dr. Harmon underwent five years of extensive training in head at neck surgery at the prestigious residency program at the University of Cincinnati. Dr. Harmon then underwent focused fellowship training in cosmetic facial plastic surgery through the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) with the world-renowned surgeon, Dr. Andrew Jacono, on Park Avenue in New York City. Request a consultation Request a consultation with Dr. Harmon at Harmon Facial Plastic Surgery in Cincinnati. Visit our clinic. You will learn more about Dr. Harmon's credentials, style and approach. Build a relationship with our dedicated team. Do not stop at searching "plastic surgery near me." Get in touch with us to learn more! Contact Us References 1. Heitmiller K, Ring C, Saedi N. Rheologic properties of soft tissue fillers and implications for clinical use. J Cosmet Dermatol. 2021 Jan;20(1):28-34. 2. Sundaram H, Rohrich RJ, Liew S, Sattler G, Talarico S, Trévidic P, Molliard SG. Cohesivity of Hyaluronic Acid Fillers: Development and Clinical Implications of a Novel Assay, Pilot Validation with a Five-Point Grading Scale, and Evaluation of Six U.S. Food and Drug Administration-Approved Fillers. Plast Reconstr Surg. 2015 Oct;136(4):678-686.

While often beneficial for their indicated use(s), non-surgical procedures, including injectables and energy-based devices (e.g., radiofrequency, ultrasound), can alter the tissue in the areas treated by facelift and neck lift surgery. These treatments do not typically preclude surgical treatment of the face and neck. However, they can affect the healing process post-operatively. They also alter the calculus of what facelift and neck lift approach would likely be the safest and most effective. This is why an in-person consultation with a qualified surgeon who has experience operating on patients who have undergone these non-surgical procedures is essential prior to considering any facial plastic surgery procedure. It is important to seek not only a fellowship-trained but also a double board-certified facial plastic surgeon if you have aesthetic concerns about your face and/or neck. Hyaluronic Acid Filler Does Not Significantly Distort Anatomy It is not uncommon to encounter hyaluronic acid filler in the jawline, cheeks, and/or tear troughs when performing extended deep plane facelift surgery. It is understandable that many choose to pursue non-surgical treatments for age-related changes prior to considering surgery. Our experience has been that hyaluronic acid fillers do not significantly distort the anatomy because they appear distinct from normal tissue. In fact, hyaluronic acid filler appears similar in our tissue as it does in the vial. It can also be removed intra-operatively as is often desired by patients. Poly L-lactic Acid Significantly Hardens the Subcutaneous Layer Poly l-lactic acid, also known as Sculptra©, is a filler that is intended to add volume to the face long-term through the production of new collagen in the areas injected. Our experience operating on patients who have received poly l-lactic acid injections is that the tissue planes, while intact and distinguishable, are often much "harder," like scar tissue. Energy Based Devices Also Harden the Subcutaneous Layer Energy-based devices utilizing energy sources such as radiofrequency, ultrasound, and plasma can alter the anatomy of the face and neck in a manner like poly l-lactic acid. This is because the purported creation of new collagen with these devices caused by the heat they generate is often similar to scar tissue. Moreover, these devices do not lift the volume of the face and neck like facelift and neck lift surgery do. Fat Grafting Can Significantly Distort Anatomy Fat grafting – a surgical procedure – can significantly distort surgical anatomy. It is important to note that fat grafting, when appropriate, can be an effective procedure for those with significant volume loss in their face. For example, many individuals experience a significant loss of fat in their temples and could benefit greatly from fat grafting. Fat does, however, embed in the tissue such that it is more difficult to distinguish between the various tissue layers of the face. Deep Plane Facelift Surgery is Likely the Most Effective Approach After the Above Procedures Like revision/secondary facelift surgery, we at Harmon Facial Plastic Surgery feel deep plane facelift surgery is the best approach for patients who have undergone any of the above procedures. This is because the blood supply to the skin is better preserved when compared with other approaches, thereby improving healing. Also, deep plane surgery often bypasses the areas treated with the above procedures, allowing for a more effective lift. Dr. Harmon is one of the few surgeons in the world, and the only surgeon in the Cincinnati area, fellowship trained by Dr. Andrew Jacono, the surgeon who developed the extended deep plane facelift. Trust Your Face to a Facial Plastic Surgeon It is important to seek a fellowship trained specialist in plastic surgery of the face and neck when you have concerns about your face or neck. Why Choose Dr. Harmon The mission of Harmon Facial Plastic Surgery is to help people along their journey towards self-confidence, to feel good about feeling good. Dr. Harmon is a double board-certified facial plastic surgeon Dr. Harmon values making patients feel welcomed, listened to, and respected. Dr. Harmon graduated with honors from Cornell University with a Bachelor of Science degree in molecular biology. Dr. Harmon earned his medical degree from the University of Cincinnati. Dr. Harmon underwent five years of extensive training in head at neck surgery at the prestigious residency program at the University of Cincinnati. Dr. Harmon then underwent focused fellowship training in cosmetic facial plastic surgery through the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) with the world-renowned surgeon, Dr. Andrew Jacono, on Park Avenue in New York City. Request a Consultation Request a consultation with Dr. Harmon at Harmon Facial Plastic Surgery in Cincinnati. Visit our clinic. You will learn more about Dr. Harmon's credentials, style, and approach. Build a relationship with our dedicated team. Do not stop searching "plastic surgery near me." Get in touch with us to learn more. Contact Us