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This lady from Pittsburgh was concerned about the tear troughs under her eyes. I find that one of the wonderful advantages of injecting the tear trough with fillers such as Restylane® is that it tends to last a good amount of time in this area. This patient is a particularly good example of this. The before and after pictures are separated by five years, and no other treatment to the tear trough was performed in the intervening years! Most facial plastic surgeons attribute the longevity of filler in the tear trough area to the relative lack of motion in this area, others have speculated that there is a reduced amount of natural hyluronidase (a substance that breaks down filler) in this area of the face. Needless to say, the patient was very happy with this result.