Filler around the eye area.

What is the best and safest injection technique for tear troughs? I've went for 3 consults and each Dr wanted to do a different filler technique: filler with cannula superficially, filler with needle under the muscle, and filler with cannula above and below the fat pad. I'm so confused and want to make the best and safest choices, please help Dr. B - I trust you!

Thank you! Okay…….so experts DO vary on this.  This is an expert only area for obvious reasons.  Damaging the eye itself with poor or inexperienced technique would be terrible.

Part of it is that you want the doctor to use whichever technique they are most experienced with ….and best at….right?  You really don’t want them trying something on you that they really don’t know how to do.  The best, most expert injectors can use both canulas and needles equally well, in different situations.

What is best around the eyes:

  • Using a non hydrophilic filler (for example, Restylane), because it is the least likely to cause odd lumps and bumps immediately and later.
  • Working in the plane that makes sense for you anatomically.  For example, if you have a deep eye socket with plenty of fat and a thick dermis it may makes sense to work more superficially.  If you have very thin skin in the eye area, sitting directly on bone, then it may make sense to do tiny deposits with a tiny needle under the muscle.  It’s very individual!
  • If you have a malar fat pad, the derm may need to work above and below it in different planes, to camoflauge it and get a good result.
  • Have the office send you their bruise prevention protocol to help avoid bruises.

What is safest around the eyes:

  • Going to an expert injector, who has at least 10 years of experience, with the skills to use either canulas and needles depending on the situation.
  • Canulas, if they are blunt tipped and 25 gauge or less, are generally safer, but this is not always true.  I have seen complications (from other offices) when the injector is not experienced, and forces a canula where it shouldn’t go.
  • They should always be working outside or on the boney orbital rim, not inside where the eyeball is.
  • Tiny (TB syringe size) needles used correctly are also very safe.
  • We use a vein finder (Accuvein) in our office to help avoid large bruises.

I hope this helps you, and I know it’s hard because you’re getting conflicting information.  Maybe try asking more questions at the office you liked best.

Dr. B


Dr. Brandith Irwin, MD

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Hi, I’m Dr. Irwin. I believe that consumers deserve a medically trained and unbiased skin care advocate.

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