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Dermal Fillers Tear Trough

Author: Dr Naomi / 27 Oct 2015

Dermal filler can be used in tear troughs to reduce the appearance of eye bags or under eye hollowness. It is a very common treatment in our Sydney clinic

Dermal filler can be used in tear troughs to reduce the appearance of eye bags or under eye hollowness. It is a very common treatment in our Sydney clinic

Before and after 3 treatment with dermal filler injected into tear troughs. As so often with tear troughs, I am not 100% happy as there is asymmetry and I feel the result isn't perfect. However, the patient is delighted and feels that the tear trough

Before and after 3 treatment with dermal filler injected into tear troughs. As so often with tear troughs, I am not 100% happy as there is asymmetry and I feel the result isn't perfect. However, the patient is delighted and feels that the tear trough


Before and after dermal filler in tear troughs, further treatment will achieve an even better result

Before and after dermal filler in tear troughs, further treatment will achieve an even better result

After 2 treatments dermal filler tear troughs. This was a difficult case. I was worried that there might be a touch of Tyndall effect after the first 2 treatments, but see images below which are after 3 treatments, results improved

After 2 treatments dermal filler tear troughs. This was a difficult case. I was worried that there might be a touch of Tyndall effect after the first 2 treatments, but see images below which are after 3 treatments, results improved

This is the same patient as above. However, the after photo is 2 years and 5 months after the  before photo (3 treatments of 1 ml were performed originally)

This is the same patient as above. However, the after photo is 2 years and 5 months after the before photo (3 treatments of 1 ml were performed originally)

Before and after dermal filler injections for tear troughs (patient also had anti wrinkle injections)

Before and after dermal filler injections for tear troughs (patient also had anti wrinkle injections)

Before and after a series of treatments of dermal filler into tear troughs. Finally we made it:)

Before and after a series of treatments of dermal filler into tear troughs. Finally we made it:)

Tear troughs are depressions starting from the inner eye and moving outwards and downwards towards the cheek. The “lateral tear troughs” are their mirror image that start from the outside corner of the eye and travel downwards and inwards from that point.

Many patients are concerned about their under eye area, even from a very early age, and this concern intensifies over time. They can be concerned about the dark circles and shadowing under the eyes, the hollowing under the eye, the eyebag (or pockets of fat under the eye).

Dermal filler can be used to address these issues.

Injection Treatment for tear troughs

Choosing the type of dermal filler for the tear troughs

I will only use one type of dermal filler for the tear troughs and my reason for that is safety. I use the product that has good lifting capability and attracts the least amount of water.

Dose of dermal fillers

The dose required for hand filling is variable, it depends on the  patient’s anatomy, and where the patient wants to get to in terms of results.

The doctor will assess the tear troughs and decide on the best dose after taking a history and examining the patient. If a patient has a history of complications with dermal fillers, or if their budget is small or if they want a more subtle result, then a smaller dose might be chosen to start with.

We use a standard protocol for dermal filler treatment of the tear trough, which is

Treatment 1: 1ml dermal filler

Treatment 2: 4 weeks after treatment 1, 1ml dermal filler

Treatment 3: 4 weeks after treatment 2, 1ml dermal filler

Yearly treatments thereafter

When injecting the tear trough and under eye area, it is necessary to inject multiple areas to obtain the best results, and we also prefer to inject over 3 sessions to avoid the very common negative results of tear trough treatment, which include lumps and blue appearance (Tyndall Effect).

Pain relief during treatment

A numbing cream (eg EMLA or LMX ) may be applied to the area prior to the treatment (45 minutes prior is ideal) Glad wrap may be used over the numbing cream to increase its effect.

If a cannula is used, local anaesthetic is used prior to the cannula being introduced into the skin. Cannula may be used in the first treatment, but for greater precision, needles may be used in treatment 2 and 3.

There is local anaesthetic in the dermal filler

Ice is always used to decrease pain and to reduce the risk of bruising.

Very rarely patients will use Penthrox for dermal filler in tear trough.

Nitrous oxide (happy gas) is available for patients to use

What happens during the injectables tear trough treatment itself?

The area will be cleaned with alcohol and chlorhexide to help prevent infections

Ice will be applied to the area briefly before treatment The doctor will inject using a very fine needle. Then pressure with gauze will be applied.

If a cannula is used, a small injection of local anaesthetic is injected into the skin and then a fine needle makes a small hole in the skin where the cannula is inserted.

How will I look after dermal filler in the tear troughs?

There may be redness and swelling, and red dots at the injection sites. Bruising is very common with dermal filler injection in tear troughs.

If cannula is used, bruising is less common

Side effects /risks with dermal fillers in the tear troughs:

Bruising: occurs in a significant number of cases.

Swelling: in the injection area will occur. This will last for aprox 48 hours

Tyndall Effect:Blue appearance of the dermal filler under the skin

Lumps: Our 3 session technique reduces the incidence of lumps

Asymmetry: Sometimes one side is better treated than the other, this is usually because the patient is asymmetrical to start with.

Infection: is a very rare complication, but always a possibility when the needle goes into the skin.

Necrosis: (blood vessel being blocked, interfering with blood supply to the skin) is very rare. This could lead to scarring. The nose is susceptible to necrosis

Need for further treatmentIt may  take several syringes of product to get to where the patient wants to be.

Blindness: This should be discussed as there have been cases of it around the world

Instructions for care after treatment

No makeup for 4 hours

No heavy exercise that day

No acid face products for 24 hours

No spas no saunas, no hot yoga for 1 week post treatment

What to expect after the tear trough dermal filler  treatment?

The effect of the dermal filler will be obvious immediately

Most of the swelling from the dermal filler will have resolved by 2-3 days after the procedure. There may be a small amount of swelling for even 2-4 weeks after the procedure.

Bruising will last 7-8 days

What if I get asymmetry at some time before the 4 week point?

Do I call the doctor?

No. No need to call the doctor. Sometimes asymmetry will occur because one side is more swollen or bruised. Usually it will right itself by the time of the review appointment. If it doesn’t, then it can be examined at the review appointment. There is no point in coming in early for treatment of asymmetry as there is often swelling associated and so the final result cannot be seen until at least 2 weeks. Treating asymmetry too early could lead to further asymmetry. The other thing to remember is that most patients have asymmetrical tear troughs to start with. We usually try to address this

How long will the treatment last?

The answer to this is very individual and depends on the patient’s anatomy, metabolism, the dose, the placement, the product etc.

With the dermal filler  that we use, the protocol is 3 treatments, 1 month apart then yearly treatments

Cost of dermal filler in tear troughs

Cost is per syringe. Our most commonly used dermal filler for tear trough cost is $720 per ml. 1ml is used per session

For further information please see the following blog posts or use the search function on the website

 

 

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