Dr. Shervin Naderi demonstrates tear trough injections using tiny droplets in multiple planes, stopping the needle 2-4mm before withdrawal to avoid overcorrection. He recommends Restylane or Juvederm Volbella over thicker fillers, and favors needles over cannulas for precision despite higher bruising risk.
Chapters
Hi, good afternoon. We're going to show a tear trough injection. This is a touch up injection. If you scroll through the hundreds of videos we have of instructional injection, you'll see that this patient actually has had voluma to the cheeks. We've done some of the tear troughs and now we're just going to upkeep. So typically patients ask, how long does this last? It's almost not the best question to ask. You want to ask how often do I need to reinject? Because if you fill it up and then you want to wait for it to be all gone, then you start it from scratch. So how long it lasts implies that you're going to wait for everything to be gone. The best way to do this is you inject it and then you upkeep, you refill the air in the tires, you maintain it and even add to it a little bit. And that's what we're about to do today. So you'll be able to watch this today. So you're gonna keep basically where you are. There is no jabbing. It's very subtle. You can see where the teardrop is. Very subtle augmentation. You're gonna go little by little by little. Now, as I'm going in, I'm going to inject, but I don't inject all the way out. What I mean is the needle goes in and you can see the needle is about, you know, centimeter and a half to 2cm long. It goes in, but I don't inject all the way to the tip of the needle on the way out. Because if you do that, you're going to basically put your last few drops too superficial. So just about 3 millimeters to 4 millimeters before about to remove it, you can see how perfect it is. Two to three millimeters. So when the needle goes in, I penetrate, and as I'm on the way out, a little bit left on the needle, I stop and I take my finger off the plunger. So there's nothing going in. We're going to do multiple different planes. This is truly the micro droplet technique. I was one of the first few people many years ago to start talking about microdroplet and start demonstrating the microdroplet. Now it's become a catchphrase and a lot of people talk about it, and I'm glad that it's really caught on because I never like putting big globs, big boluses, and having to massage it for half an hour. That's not the best approach. So I can make half a Syringe of Restylane. One syringe of Restylane lasts a long time by placing lots of injections. If you actually look at the plunger, it's still at 1cc. So all those injections and I've barely used anything. So that's truly the microdroplet technique. Now I'm gonna have her close your eyes. Just gently hold this for me with your hand. And we're gonna go to the other side and we go back and forth a little bit. So by this time the lidocaine will kick in, it'll start numbing that side and we'll go back to it. Chin up just a little bit for me. Open your eyes for a second. We want to open the eyes and look up for me at the ceiling. I'm going to confirm where the tear trough is and go back to it. Now close your eyes. I'm going to go. This side is actually not as bad. She thought this is her worst side, but this is actually her better side. So little by little, multiple little injections, multiple planes, it's fairly superficial. I like Restylane for this and I also like Juvederm Volbella and I also like Juvederm Velour. Now can I do this with cannula? Yes. Do I do it with cannula? Yes. But the sharp needle is much more accurate. You can get it exactly where you want to go in multiple different locations. If somebody wants to have the lowest risk of bruising, I mean, cannula can still bruise, but it's much lower risk of bruising. And it's often zero bruises with cannula. That's the technique to go with. But if you want the most accurate results, the sharp needle allows you to basically penetrate and go where you need to go. And you can see very tiny bruiser, but you can see how smooth it is. It's perfect in that area. I need to go right up here a little bit. You can see the needle right there. That's how the injection is done. So that's basically it. This is. I'm gonna have you hold it there. That's essentially the technique. It's a fine tuning. You don't need a lot of volume, you don't need large amounts. You just have to be in the right plane, the right place and be very gentle. Don't put a big glob and then have to regret it, Melt it, massage it. Just go accurate and be cognizant of what plane you're in and what material you're using. Restylane Volbella and Valor. Sometimes even Voluma in patients with thicker skin. But definitely, definitely don't use Juvederm Ultra Ultra Plus. Those you should stay away from. Thank you.
