The Tick technique: A method to simplify and quantify treatment of the tear trough region

Abstract

Background The hollowing of the infraorbital area (tear trough) is anatomically complex, and complications are frequent with its treatment. A simplified, quantifiable, and reproducible technique should encourage more novice injectors to confidently address this region. Aims The aim of this study was to evaluate the efficacy of a simplified method of treating the tear trough by using BD insulin syringes with fixed 6 mm 31G needles. Patients/Method A total of 150 sequential patients were divided into Hirman's three grades of tear trough deformity and were injected with up to three small boluses of hyaluronic acid at three defined anatomical regions. The amount injected varied with the grade of volume loss but all injections were deep on periosteum and under the orbicularis oculi muscle. Patients photographs before and after were reviewed to assess the outcome. Results All patients at all time points (immediate, 1 week, 1, 3, 6, and 12 months) were improved by patient and physician assessment. Approximately 90% at all time points rated their results as “very” or “exceptionally” improved. Adverse events were short term and included swelling, redness, pain, and bruising. No adverse events seen after the 1‐week visit. No Tyndall effect was noted throughout the study and no filler required removal. Conclusion This interventional‐observational study illustrates the value of a simplified and quantifiable injection technique with predictable and satisfactory outcome and a low complication rate. We propose a possible way forward for aspiring aesthetic physicians to treat tear trough with confidence to minimize complications and maximize the outcome.

Hyaluronic acid for lower eyelid and tear trough rejuvenation: review of the literature

“…There were eighteen prospective studies [12][13][14][15][16][17][18][19][20][21] , twenty retrospective studies [22][23][24][25][26][27][28][29][30][31] , and one that was both retrospective and prospective [32] ; the study type was not mentioned in twenty-seven [33][34][35][36][37][38][39][40][41][42] .…”

“…Among the investigated articles which directly mentioned the study population [14][15][16]21,26,32,34,63,[66][67][68] , the average (n) was 71.37, and ranged from 3 [18] to 400 [11] once case reports were excluded.…”

“…Research focused on personal techniques purposed by the authors have been published since 2005. Airan and Born [11] and Kane [12] wrote the first articles ever about this topic, both in 2005; technique refinement and new trends have been published in 2006 [22,23] , 2007 [24,33] , 2011 [16,32,76] , 2012 [26,41,42,66] , 2013 [73] , 2014 [43] , 2015 [48][49][50] , 2016 [27,28] , 2017 [17,52] , 2018 [19,71,74] and 2019 [21] .…”

“…Injections performed by needle have been described since 2005 up to 2019 [11][12][13][14][15][16]21,28,33,74] , while cannula use has been reported since 2017 [19,30,31,52,71] and only two studies reported both techniques [17,62] .…”

“…Indeed, publications on injection techniques constitute the majority [11][12][13][14][15][16][17][18][19][20][21][22]31,33,71] of the recorded articles.…”