Management of Tear Trough with Hyaluronic Acid Fillers: A Clinical-Practice Dual Approach

Abstract

Introduction: Tear trough deformity (TTD) is currently a major concern for many individuals that seek periorbital rejuvenation. Among the different options currently available for treating TTD, hyaluronic acid (HA) filler injections have become increasingly popular. Purpose: To provide a dual approach, direct and indirect strategies for treating TTD with HA fillers according to patient facial structure. Methods: The current paper combined the authors' experience with the currently available scientific evidence. Results: The current study presents the authors clinical experience regarding TTD treatment and serves as a guide on the best therapeutic approach with HA fillers. For achieving good aesthetic outcomes, especially in TTD, it is crucial to have a detailed understanding of both facial anatomy and the individual characteristics of the HA fillers. Proper management of full-face facial rejuvenation should have into consideration three main pillars: structure, contour, and refinement. Conclusion:Treatment of TTD should be addressed from a comprehensive perspective, including potential lack of structural support, as well as interventions on the dynamic processes involved in the problem. Additionally, HA fillers can be used to modulate mechanically muscle movement by either facilitating their action or decreasing contractility by reducing their movement. Clinicians can benefit from ongoing guidance on the use of these products in order to tailor and optimize treatments to patient's requirements. Although HA filler injections have low rates of side effects, TTD was listed as the most challenging area to treat with HA. Therefore, TTD treatment should be performed only by well-trained and experienced specialists.

Infraorbital mass long after dermal filler injection: A report of two cases

“…The increasing demand and popularity of treatment of the periorbital area have been observed among patients, especially in the inferior orbital rim, due to the aging effect resulting in a loss of the suborbicularis oculi fat pads, since hollow eyes give the appearance of tiredness. HA fillers were FDA approved in 2003 and have been preferred by those looking for a quick, temporary, nonsurgical procedure with minimal side effects 10 …”

“…HA fillers were FDA approved in 2003 and have been preferred by those looking for a quick, temporary, nonsurgical procedure with minimal side effects. 10 Periorbital foreign-body granulomatous reactions have been published in few cases after dermal filler injections. Delayed onset granuloma formation at the right medial lower eyelid area after two injections of HA fillers (2 years and 10 months previously, respectively) was reported.…”

Infraorbital Hollow Rejuvenation: Considerations, Complications, and the Contributions of Midface Volumization

“… 21 , 25 In general, an HA filler with lower elasticity and firmness is recommended for treating infraorbital hollows. 2 , 24 , 49 Fillers that can pass through a 30G or 32G needle are preferable to those requiring larger bore needles.…”

“… 10 , 16 , 36 Technical recommendations and best practices for injecting HA fillers are summarized in Table 2 . 6 , 17 , 24 , 25 , 49 , 52 Figure 4 shows representative patients treated with HA fillers to correct infraorbital hollows.…”

Myomodulation with Facial Fillers: A Comprehensive Technical Guide and Retrospective Case Series

“…Instead, placement of a collagen biostimulator (e.g., poly-L-lactic acid, calcium hydroxyapatite) is advised. [7] 3A and 3B: The Inferior Temple and Eyebrow Arch Areas 3A and 3B comprise the superior orbital rim and lateral orbital rim extending to the temporal hairline. This area should be treated with extreme caution to avoid the temporal branch of the facial nerve and the temporal vessels as well as the supraorbital and supratrochlear nerves, arteries, and veins.…”