The tear trough deformity is a concave hollowing that develops under the eyes that becomes more pronounced as we age. It is the junction between two facial muscles that is often made more obvious by bulging of the fat pad under the eye. It leads to a shadow under the eye which gives a tired and worn out appearance.
An important consideration in tear trough filler is to ensure that there is adequate support in the cheek & midface before the procedure is performed. Often by doing this alone the tear trough deformity is improved and does not require treatment directly.
What we can improve with tear trough filler
- Dark circles & shadows under the eye caused by the tear trough deformity.
It is important to note that in some patients the dark circles are due to pigmentation in the skin. This cannot be corrected with dermal filler, but rather with laser modalities or topical treatments.
- Correction of hollowing on the outside (lateral) area of the eye
- Support to the tissue around the eye
- Improvement of the texture of the eye skin
- Treatment of fine wrinkles on the lower lid skin
FREQUENTLY ASKED QUESTIONS
Typically very small amounts of a dense filler are used deep on bone. This allows for the deformity to be corrected without causing a ‘puffy’ look under the eyes.
Pain is very minimal during the procedure. Topical anaesthetic can be used, but is very rarely required.
This procedure is often done in two stages spaced 2-4 weeks apart. The reason for this is that filler by its very nature will attract water and a small degree of swelling is expected. So the aim is generally for an 80% correction in the first visit and then to further refine it in the following visit. This allows for adequate correction without causing ‘puffiness’ under the eyes.
As with any medical procedure there are some risks to consider. Most patients will have some degree of swelling associated with this treatment, but this will settle over the following few days. There may be some discomfort, bleeding or bruising. There have been cases in Australia of vascular injury whereby filler is inadvertently injected into a blood vessel. It is very rare but if it occurred could lead to necrosis of the skin or visual loss. A thorough knowledge of facial anatomy and safe injecting techniques can greatly minimise this risk, however if any signs were to occur the filler would need to be dissolved immediately.
It should be pointed out that this is a common area for bruising to occur due to thin skin and multiple blood vessels in this area. There are certain techniques that can be used to minimise this risk and, although it does not happen commonly, should be expected. Therefore, filler in this area should not be considered if there is a special event that you are planning in the next fortnight where a bruise would not be acceptable in case this should occur. However, if it does occur it can be minimised by applying ice for 24 hours afterwards and camouflaged with makeup.
The other consideration of filler in the tear trough deformity is a poor aesthetic outcome. This can occur for several reasons, including:
- Filler placed too superficially in the skin. This can lead to a blue appearance in the skin (known as the Tyndall effect).
- Too much filler used (or overcorrection) causing ‘puffiness’ under the eyes. This is why the procedure should be performed over two visits.
- Performing the procedure on the wrong patient. Identifying patients who will not get a good outcome is vitally important in tear trough filler. Common times when it would not be appropriate are in patients with poor skin laxity, large eye bags or seasonal allergies.
It is for these reasons that it is important to see an experienced cosmetic physician with a good knowledge of facial anatomy and who understands how to avoid complications so that you can get the best possible outcome in the safest way.
There is generally minimal recovery for this procedure. However if a bruise occurs there may be swelling and discolouration that can take up to 2 weeks to resolve.
No makeup or lipstick for 4 hours. No exercise for the next 24 hours. Avoiding alcohol that evening will minimise any bruising. Applying ice will also help with swelling and bruising. No swimming for one week.