What are tear troughs?
Tear troughs are the hollows between the lower eyelid and the cheeks. This groove is often an aesthetic concern as it may cause the appearance of tiredness and is often treated with dermal fillers. In many cases, tear troughs are genetic rather than a result of ageing, and often appear even in teenage years. Alternately, tear trough grooves can also be a result of mid-cheek volume loss and therefore support of the lower eyelid. We term this ‘pseudo-tear troughs’. Their appearance is similar to tear troughs, but the difference is that the skin in the groove is not tethered to underlying structures. Due to the lack of tethering, a lateral pull on the skin of the lower eyelid will correct a pseudo-tear trough. A tethered tear trough will often not be corrected by this manoeuvre. This difference also means a difference in the method of treating these tear trough variants with dermal filler.
How can I treat my tear troughs with dermal filler?
The appearance of and tear troughs can be reduced through the injection of dermal fillers.
Tear troughs can be corrected by injecting dermal filler directly in the groove between the lower eyelid and cheek. This lifts the tear trough up to the level of the lower eyelid and cheek, thus smoothing the appearance of the area. Fillers placed in this area often last for many years.
Loss of volume in the mid-cheek also can cause hollowing between the lower eyelid and cheek. It is possible to replace volume in the mid-cheek using dermal fillers which can help with this problem.
It is important to note, however, that mid-cheek volume loss and tear troughs are often present in combination with each other so that it is necessary to treat both these problems by filling the mid-cheek as well as the tear trough directly.
What type of dermal fillers are used for the tear trough area?
The most common fillers that are used for the tear trough area are made from a substance called hyaluronic acid. Hyaluronic acid is composed of chains of sugar that are cross-linked to give it a gel consistency. Forms of hyaluronic acid are also naturally found in the skin, eyes, and joints in the body.
One of the advantages of hyaluronic acid fillers are their reversibility. A substance called hyaluronidase can be injected into the area to dissolve the filler. This does not affect your normal skin or tissues, and only affects the dermal filler. Left alone, the hyaluronic acid filler will last in the tear trough area for some years.
The difficulties of using hyaluronic acid fillers is their natural hydrophilic nature, that is, they attract water. This can cause difficulties with estimating how much filler needs to be injected into the tear troughs, as the initial appearance post-treatment may be less than the final result. Therefore, it is necessary to underfill the area and estimate the amount of hydration that will subsequently occur.
We do have dermal fillers that are specifically made for the tear trough area. These are fillers that tend to blend well into the area and are less likely to cause puffiness after treatment.
What techniques are used at Fab Aesthetics to treat tear troughs with dermal fillers?
When we first started treating tear troughs, we used needles to inject the filler. The risk of bruising using this technique was extremely high. Most patients would experience a week or more of significant bruising. This led us to Cannula technique.By using a blunt tipped cannula, it is possible to feed the filler into the tear troughs and push blood vessels aside and reduce the chances of bruising.