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The tear trough is the region of hollowing between the lower eyelid and the cheeks. Problems in this area of the face can leave you with dark circles, under eye hollowing and can leave you looking tired. This problems can be accentuated by aging, weight loss, fatigue and occasionally sinus conditions. More commonly a hollow tear trough is due to genetics, or can be due to lack of lower eyelid support and mid cheek volume loss.

At Avissa Skin we offer a range of treatments for the tear trough area.  These treatment options reduce fine lines, soften dark circles, eliminate puffy under eye bags and fill hollows. Dark circles under eye and under eye hollows are best treated with dermal fillers and/or biological stimulation with platelets ( PRP ). Fine lines and wrinkles can be treated with our advanced resurfacing lasers, radiofrequency microneedling and neurotoxins.

Non-Invasive, Quick Procedures, Immediate Results with Minimal Downtime, Last 6-24 months.

Natural is always our top priority and our export injectors at Avissa Skin will create a individualized treatment plan tailored to your specific under eye goals at your consultation. 

Treatment of the under-eye region varies from person to person and often requires an individualized treatment plan. This is determined following a in depth consult and understanding your individual aesthetic concern and following considerations:

The depth of the tear trough   |   Hollow tear troughs can be treated with dermal filler that has been specifically designed for the under eye area. Moderate to severe tear troughs concern may require a staged treatment approach 2-4 weeks apart to achieve the desired results.

Mid-face volume deficit   |  
The tear trough area requires support from the cheek area underneath it. Flattened cheeks can cause the appearance of hollow tear trough due to the lack of structural support so correcting mid-face volume deficit can significantly improve the under eye area.

Outer ring of the tear trough   |  
Filling this area can smooth the transition between the tear trough and the cheek and provide support to the tear trougha area.

Under eye bags   |  
Under eye bags can become more visible as we age due to loss of surrounding tissue, laxity of skin and collagen. Under ye bags can be treated targeted combination therapies and/or surgery.

Under eye dark circles   |  
Dark circles are caused by genetics, underlying sinus issues, hollowing, or pigmentation and are treated by laser resurfacing, dermal fillers and stimulating injections with PRP/PRF.

Ask our aesthetic nurse about
PRP/PRF procedure for undereye!


Dermal Filler
There are many fat pads surrounding the eyes and brows that either lose volume or sag due to gravity. Volumizing the medial and lateral cheek defects will often give significant improvement to the eye area without injecting in the tear trough and are always treated first. If there is still a deficit in the tear trough, conservative volumes of filler can be injected deeply in the tear trough. It is always better to under correct this area and schedule a follow-up visit in 2-3 weeks. When a patient has prominent eyebags, filler can sometimes be used to camouflage the bulging fat. However, if the patient already has a full cheek, placing filler in the tear trough area can worsen the appearance. These are patients who require lower blepharoplasty. Brow lifting is possible with filler placed in along the superior orbital rim and in the temples.

The quickest and easiest treatment around the eyes is using neurotoxin. By relaxing the orbicularis oculi muscle, improvement in wrinkles known as crows feet is achieved. Elevation of the brows is created by relaxing the same muscle closer to the tail of the brow.

Fractionated Resurfacing Laser
laser skin resurfacing can lighten dark skin tones as well as induce new collagen formation in the skin, resulting in the reduction of dark circles and lines. The fractionated resurfacing laser delivers a series of microscopic, closely spaced laser spots to the skin, while simultaneously preserving normal healthy skin between the laser spots. Fine lines around the eyes can noticeably fade for those who undergo this treatment, as well as uneven coloring and brown spots caused by aging and sun exposure.

Platelet Rich Fibrin ( PRF )
When injected as an under eye filler, PRF is an all natural way to improve under eye pigmentation & tone, it also enhances skin firmness, texture and thickness. Platelet Rich Fibrin is the second generation to Platelet Rich Plasma (PRP) and involves the use of your body’s own platelets.

Plasma Fibroblast Skin Tightening
The plasma pen treatment is highly effective for tightening skin below the eyes and smoothing away bags as well as sagging eyelids. The plasma heat creates small bursts that leave a small dot on the skin, a minor injury that stimulates contraction and repair of the skin. Multiple dots are applied to the under eye area during treatment to smooth and tighten the skin.

Ask us about

At Avissa Skin, we only ever use hyaluronic acid filler, because it’s a naturally occurring sugar that creates a smooth, born-with-it look without the side effects associated with permanent fillers. That it gets naturally metabolized by the body overtime is a good thing – even if it’s annoying having to get the area re-treated. We also have a product called hyaluronidase which can dissolve hyaluronic acid immediately if there is a complication, or if you don’t like the result. Hyaluronic acid fillers are super versatile and with the right technique, deliver a great, natural look. Some of our favorite HA filler products include but are not limited to RHA Designer Collection, Restylane and Juvederm.

RHA® Collection of designer fillers
Only available at select practices
Designed by TEOXANE Laboratories in Geneva, Switzerland, the RHA® Collection of hyaluronic acid fillers are the only FDA-approved hyaluronic acid fillers for dynamic wrinkles and folds. Like other HA dermal fillers, RHA® is made from hyaluronic acid—but RHA® is different, because it’s made differently. RHA® uses a gentle manufacturing process. This process helps preserve the natural structure of the HA, helping it mimic the natural HA found in your skin. RHA® is the latest advancement in HA filler technology, purposely designed to perform in the most dynamic areas of the face without looking stiff or unnatural. There are three formulations in the RHA® Collection, and your provider will help you determine which one is best for your treatment plan.

Restylane® Collection of fillers
The Restylane® line smooths away facial wrinkles and folds ( Restylane, Restylane Lyft, Restylane Refyne, Restylane Defyne ), provides subtle lip enhancement (Restylane Kysse, Restylane, Restylane Silk ), smooths the lines around the mouth ( Restylane Silk ), adds lift and volume to the cheeks ( Restylane Lyft ), and helps reverse the signs of volume loss in the back of the hands ( Restylane Lyft ).

JUVÉDERM® Collection of fillers
JUVÉDERM® is a collection of fillers to temporarily lift & contour cheeks ( Juvéderm® Voluma XC ), Chin ( Juvéderm® Voluma XC ), smooth lines ( Juvéderm® Vollure XC,  Juvéderm® XC ), or plump lips ( Juvéderm® Volbella XC,  Juvéderm® Ultra XC )

The minimally-invasive nature of dermal filler injections, with fast treatments and no downtime make it a popular procedure among men with busy schedules who want to look and feel their best.

Myth #1 – Botox and fillers are the same thing.
Contrary to popular belief, Botox is not a filler. Botox causes the muscles to relax so the appearance of fine lines and wrinkles decreases whereas dermal fillers actually add volume to your face to fill out those extra folds of skin. Though both Botox and dermal fillers serve similar purposes, the treatments reach the desired results through distinct physical alterations.

Myth #2 – Everyone will notice I’ve gotten fillers.
This is a fear for many individuals because they have witnessed how the media torments celebrities and other public figures based on their personal choices about cosmetic procedures. Although you may be worried that you will look drastically different or fake after receiving dermal fillers; however, there could be nothing further from the truth. Dermal fillers, when administered by a certified and experienced professional, provide natural-looking results that still deliver the plumping you desire.

Myth #3 – Fillers are extremely painful.
We understand many people have a particularly acute fear of needles, but there is nothing to be afraid of when it comes to fillers.  Most providers apply topical anesthetic before the treatment which helps to minimize significantly any discomfort.  Many fillers are mixed with lidocaine to ease any discomfort that the initial injection might cause.

Myth #4 – You can’t undo a cosmetic treatment.
This might be the case in many other cosmetic treatments but dermal fillers have a lot more flexibility. If you decide to use the naturally-derived hyaluronic acid as your dermal filler, then this can be reversed almost instantaneously. By injecting hyaluronidase, HA filler can be automatically reversed because it breaks down the hyaluronic acid under your skin quickly. Most dermal fillers are temporary, lasting sometimes as little as three months, so you are not making a lifelong commitment by trying them out.

Fascinating Facts on Fillers
#1 – Fillers can stimulate collagen growth so over time so you may require less injections later on than when you first started.

#2 – The effects of most fillers are temporary, some of them being reabsorbed into the body after three months. If you seek a more permanent solution, there are a few types of fillers that can last several years.

#3 – It need not only be used for facial rejuvenation. It can be used to smooth wrinkles and hide veins in the hands. Many practitioners even suggest fillers to support droopy earlobes.

#4 – Side effects and complications are extremely rare with dermal fillers.

#5 – It would take quite a lot to over-do it when you are working with a qualified professional; you won’t get anywhere near looking overdone unless you opt for too many syringes of fillers all in one session.

#6 – A common (but flexible) rule for fillers is one syringe per decade. Get three syringes at thirty years old, four at forty years old, and so on and so forth when you have a treatment session per year.  The syringes can be spread across various areas (including off-label ones) such as lips, smile lines (nasolabial folds), cheek depressions (cheek hollows and malar volume loss), jowls (marionette lines), and temples (for hollowing).

Preparing for facial filler
Truth be told, there isn’t a whole lot of necessary preparation for facial filler. However, it’s key to note that some bruising (at the injection site) and possible swelling may occur. Therefore, it is wise to schedule your appointment at least two weeks before an important event.

To help prevent bruising, avoid blood-thinning medications, including pain relievers and supplements like fish oil for a week prior to your appointment. (Also, smokers have an increased likelihood of bruising.) You may wish to take the holistic supplement Arnica Montana several days leading up to your procedure, as this helps to minimize the chances of bruising, as well.

Here’s what you can expect during your dermal filler appointment:

Assessing your condition
During your consultation, our cosmetic injector specialist will carefully evaluate your skin condition and facial appearance. This will include your skin tone, as well as the features of your face that would look better augmented. Such areas will be marked appropriately to serve as guide during the actual treatment later on.

During your treatment
During your treatment, you will be made comfortable, and a topical numbing cream will be applied. The numbing cream will be removed after an appropriate amount of time, and your aesthetic nurse injector will cleanse and prepare your skin for treatment. You will feel a pinch upon initial injection and will feel some pressure as the product is delivered. Many of the dermal filler products have a numbing agent in them, so you will continue to feel less of the treatment as it goes on. Most patients find the treatment very tolerable. Your aesthetic nurse injector may manipulate the product as needed.

Going through recovery
Once the necessary filler has been administered, your skin is cleansed again to remove any markings. While you may feel some discomfort, swelling, or tenderness in the area, ice packs and pain medications usually do the trick.

Dermal fillers are a no downtime procedure. After treatment, you’ll be able to leave our offices immediately. You’ll be able to drive yourself home. Many patients actually head right back to work. Redness, tenderness, and swelling can occur, but typically are minor and fade over the course of a few days. Makeup can be applied to cover any redness you may experience. It is important that you do not push or press on the treated areas. It is important that you do not disturb the areas where the product has been placed.

Note that the dermal filler treatments are dosed in syringes, and each area of the face differs in how much product is needed to achieve full correction. No two people will have the same dosing. It is more helpful to think of dermal fillers in terms of results, versus actual syringes used. Volumize treatments do take time to reach efficacy/settle in, typically 3 – 4 weeks. Typical duration of dermal fillers is anywhere from 6-18 months, depending on the product used. While it would seem logical to request only the longest lasting dermal filler product, not all dermal fillers are suited for the same areas. Your aesthetic nurse injector will determine which product will give you your best outcome.

How Long Will It Take Me To See Results After Dermal Filler Injections? After getting dermal filler injections, you will be able to immediately see some results, however, it will take about 48 hours to see the full effect. The results will  typically last from 6-18 months depending on the area being treated and body’s metabolic rate. After this period of time, you will need to receive fillers again to maintain your rejuvenated appearance. If you opt to stop getting injections at any time, your appearance will just revert to its original state.

How Long Will The Results From Dermal Fillers Last?
Dermal fillers fade very slowly and gradually, so for the vast majority of patients, results should last between 6 and 18 months. After approximately 6 to 18 months, the effects of the dermal filler gradually weaken, until your skin returns to its natural state. The specific amount of time dermal fillers last varies depending on the patient’s skin, the treatment area, one’s metabolic rate, and the type of product used.

As treatment with dermal fillers is temporary, they require touch-up injections for maintenance, and eventually repeat injections. At Avissa Skin, our experienced practitioners will determine the ideal time interval for your follow-up treatments, and develop the optimal injectable regimen to suit your needs. Alternatively, if you decide not to maintain your new appearance, the results will gradually disappear over time.

How Long Is The Recovery From Dermal Filler Injections?
After receiving your dermal injections, you might experience some mild redness, swelling, tenderness, bruising, or itching. These effects should clear up in less than 7 days (or 14 days for lips). Redness can be concealed using foundation or concealer. In general, most patients experience little or no downtime – which means you can return to work and continue with your usual daily activities.

How Much Do Dermal Filler Injections Cost?
The cost of dermal filler injections depends primarily on the amount of dermal filler injected, which in turn depends on the amount of product you require to achieve a significant result. At your consultation at Avissa Skin, your unique facial features will be assessed, your concerns will be taken into account, and a treatment plan will be developed. At this point, you will be told the exact amount of filler you will require.

Are Dermal Filler Injections Painful?
Most patients only experience mild discomfort. As the needles used for dermal fillers are very fine, the amount of pain experienced by patients is minimal and the procedure does not require anesthesia. It should also be noted that many of the dermal filler products available today contain Lidocaine, a local anesthetic, to minimize your discomfort. Topical numbing creams can be used to further minimize discomfort when injecting sensitive areas.

Are Dermal Fillers Reversible?
Fortunately, there is the option of completely reversing the results you obtain from Hyaluronic-Acid based fillers if you are not happy with the results. A solution called Hyaluronidase is simply injected into the treatment site which effectively dissolves the filler within approximately 24 hours.

At What Age Should I Start Getting Dermal Filler Injections?
The age at which you start using dermal fillers depends entirely on the type of issue you’d like to address. While severe wrinkles and folds typically become evident well into middle age, fine lines appear much earlier. Moreover, there are a number of issues which dermal fillers are very effective at addressing, that are not always related to aging, such as a sunken appearance, thin lips, and wide jawbone. In general, however, dermal filler products should not be used in individuals under 18 years of age.

Are Dermal Filler Injections Safe?
Dermal fillers are approved by the FDA, and have an excellent safety track record. Additionally, the dermal fillers used at Avissa Skin in Ann Arbor are all Hyaluronic Acid-based, which is a substance that naturally occurs in our bodies, and has been used for over 20 years for arthritis treatment, wound repair, and eye surgery.

Possible Complications
Dermal fillers are very similar in composition to the Hyaluronic Acid that naturally exists in your body, as such it is very unlikely to induce an allergic reaction. To reduce the risk of complications and ensure your safety, your practitioner will review your medical history, including allergies and medications, at your initial consultation to determine whether you are an appropriate candidate for fillers.

The most common complications associated with fillers include receiving results other than you had intended, tiny lumps or irregularities under the skin, and prolonged redness. After receiving dermal filler injections, patients prone to cold sores may develop an outbreak. Those with HSV-1 should therefore be treated with a course of antiviral medication prior to the procedure. More serious complications such as infection and tissue necrosis are exceedingly rare.

Contraindications include but are not limited to the following:

          • Pregnancy, trying or breastfeeding
          • Severe allergies or a history of anaphylaxis to components of the particular filler or local anesthetics
          • Blood thinning medications within the last week
          • History of surgical face lift
          • Recent COVID/Flu vaccine or positive COVID test
          • History of keloid scarring or abnormal wound healing
          • Poorly controlled medical conditions (i.e. diabetes, vascular)
          • Impaired immune system and/or use of immunosuppressive medications
          • Active inflammation or infections (e.g. cysts, pimples, rashes or hives).
          • Impaired judgment, psychological conditions, and substance or alcohol abuse
          • Patients with unrealistic expectations

Compliance with the recommended pre / post-care instructions as well as recommended follow-up visits by your practitioner are crucial in minimizing the risk of side effects and complications. It is your responsibility to inform your practitioner of your most recent sun exposure, new medications, or changes in medical history before each treatment is performed.

Before Your Treatment

          • You may not be pregnant, trying to be pregnant, or lactating.
          • It is not recommended to have a dermal filler injection treatment less than 2 weeks before a big event.
          • You should not schedule any vaccination or invasive procedures for 2 weeks before or after treatment with dermal fillers. These include but are not limited to COVID/Flu vaccine, dental dental work, lesion excision or biopsy, surgery of any kind, tattoo or permanent makeup.
          • History of surgical face lift of any kind will lead to denial of dermal filler treatment to the midface or cheek region.
          • Inform your practitioner if you have a history of medication allergies, history of anaphylaxis, and any other medical conditions.
          • If you are prone to cold sores, it is recommended to take an antiviral medication for 3 or more days before and after your treatment.
          • To minimize bruising or bleeding it is best not to take any blood thinning or NSAIDs medications, vitamins, and supplements (unless otherwise prescribed by your doctor) for at least 3 days to 1 week before your treatment.
          • If you have a tendency to bruise easily, you may start taking over-the-counter Arnica Montana tablets 3 days before your treatment.
          • Do not apply potentially irritating products for 2 days before and after your treatment (e.g. tretinoin, retin-a, glycolic acid, hydroquinone).
          • Avoid alcohol, caffeine, and cigarettes for 24-48 hours before and after treatment as they may contribute to increased swelling or irritation.
          • Stay hydrated by drinking 8+ glasses of water daily to improve results & healing time.
          • Always use an SPF 30 or higher containing zinc oxide and/or titanium dioxide for proper sun protection.
          • Reschedule your appointment If you develop a cold/flu, cold sore, blemish, or rash, etc. in the area to be treated prior to your treatment.
          • It is recommended that you wait at least 2 weeks after other cosmetic treatments such as lasers, peels, microneedling, or facials.
          • Arrive with clean skin free of any lotion, oil, makeup, powder, or sunscreen.

Day of Treatment

          • Notify your practitioner of any changes in your medication, health status, or personal activities that may be relevant to your treatment.
          • Topical numbing cream for 30-45 minutes or regional nerve blocks may be administered to maximize your comfort during the procedure.
          • You may experience a mild/moderate amount of tenderness and discomfort during your procedure.
          • We ask that you wait at least 2 week after injection to assess the need for additional treatment to achieve desired results. Regular charge applies to all subsequent treatments.

After your treatment

          • Immediately after the treatment, there may be redness, bruising, swelling, tenderness, and/or itching near the injection site. Avoid touching, rubbing, picking, or manipulating the injected area(s) for 6 hours after your treatment. This is normal and generally disappears within a few hours to a few days. If these symptoms last more than 3 days, please contact your practitioner.​
          • Do not massage the treatment area unless instructed to do so.
          • Minimize excessive movement of the treated area(s) for 3 days after treatment to avoid potential migration of dermal filler products.
          • If there is a visible bump, you may gently massage the area. You may feel lumpy and/or bumpy for a few weeks afterwards. This is normal. The key is not to see the lumps. You may also feel  “firmness” which will soften and settle with time (usually 1-2 weeks).
          • You may take Acetaminophen/Tylenol if you experience any mild tenderness and discomfort.
          • You may take over-the-counter Arnica Montana tablets or apply Arnica Montana topical cream to help reduce bruising.
          • Apply a cool compress to the treatment area (do not apply ice directly to the skin) for 10 minutes every half an hour on the day of treatment.
          • Sleep on your back for the first few nights to relieve pressure on the area and avoid disturbing the filler.
          • Avoid alcohol, caffeine, and cigarettes for 24-48 hours before and after treatment as they may contribute to increased swelling or irritation.
          • Avoid vigorous exercise, sun and heat exposure for 3 days after. (i.e., sunbathing or tanning bed)
          • Always use an SPF 30 or higher containing zinc oxide and/or titanium dioxide for proper sun protection.
          • Avoid submerging head under water for a full 24 hours after midface treatment; this includes pools, beach, bathtub, hot tub, etc.
          • Do not apply potentially irritating products for 2 days after treatment  (e.g. tretinoin, retin-a, glycolic acid, benzoyl, hydroquinone).
          • Try to avoid wearing makeup or lipstick until the day after treatment. Earlier use may cause pustules. If you must wear makeup, we recommend a good quality mineral makeup for the face or Aquaphor ointment for the lips.
          • Continue to avoid blood thinning or NSAIDs medications, vitamins, and supplements (unless otherwise prescribed by your doctor) for at least 1 week after.
          • Avoid scheduling any vaccination or invasive procedures for 2 weeks after treatment with dermal fillers. These include but are not limited to COVID/Flu vaccine, dental dental work, lesion excision or biopsy, surgery of any kind, tattoo or permanent makeup.
          • Avoid cosmetic treatments such as laser, ultrasound, peels, facials or microdermabrasion for 2 weeks after.
          • Schedule a follow-up appointment 14 days after your treatment  for your practitioner to assess the outcome.

If you experience any side effects, such as prolonged discomfort or swelling, a histamine reaction, or infection, immediately contact your practitioner for proper assessment and care instructions.

Do you want to find out if under eye enhancement is the right aesthetic treatment for you? Contact Avissa Skin clinic today for more information on the best Under Eye Enhancing Procedures Ann Arbor, Michigan has to offer, for information on other cosmetic procedures, or to schedule a consultation. We look forward to hearing from you!