Hyaluronic acid filler in the tear troughs can address specific concerns about the interface between the lower eyelid and cheek. Seek a fellowship-trained facial plastic surgeon to help determine whether placement of hyaluronic acid filler in the tear troughs is an appropriate treatment for your concerns.
Tear Trough Filler: An Explainer
Dr. Jeffrey Harmon
The tear trough breaks a smooth, youthful transition from the lower eyelid to the cheek
A youthful face has a smooth transition from the lower eyelid to the cheek. The tear trough is a line or depression that develops at the border between the lower eyelid and cheek. It worsens as the cheek droops and the lower eyelid bags develop. The tear trough is not a wrinkle but the location of a ligament separating the lower eyelid fat from the cheek fat. The deeper the tear trough the more visible it becomes due to its shadowing effects.
Filler is placed precisely in in the tear troughs with a microcannula
Hyaluronic acid filler such as Restylane© products can be used to soften the appearance of the tear trough. Restylane© and most Juvederm© brand hyaluronic acid fillers are FDA-approved products but placed in the tear troughs off-label, meaning FDA-approval was not sought specifically for placement of these products in the tear troughs. Currently the only hyaluronic acid filler FDA-approved specifically for placement in the tear troughs is Juvederm© Vollbella© XC. Other products have long been used safely and effectively in this area off-label, though it is important that injectors have a conversation with their patients about this fact. A blunt-tipped microcannula rather than a needle is used to deposit the filler at the tear trough precisely, adding enough volume to treat the site without adding so much that the lower eyelids look “puffy.” The microcannula reduces the risk of bruising and swelling as well as the risk that the filler is injected into the wrong location, including a blood vessel.
Filler can soften the tear troughs in individuals with appropriate anatomy
The best candidates for placing filler in the tear trough often have a deep tear trough without severe lower eyelid bags. One should be cautious placing filler in the eyes with severe lower eyelid bags because it is more likely to make the area look “puffy.” Some swelling is expected after treatment, however. The swelling resolves gradually over a few days in most patients. Patients are counseled to apply cold compresses to their lower eyelids and cheeks for the first 48 hours after treatment to accelerate this process.
Some individuals are more likely to benefit from lower eyelid surgery (blepharoplasty)
Deep tear troughs with lower eyelid bags are usually best treated with lower eyelid surgery (blepharoplasty). A consultation with a facial plastic surgeon is recommended to determine candidacy for this procedure, because there may be factors that preclude this procedure for certain individuals. A detailed history and physical should always be performed prior to making the decision as to whether hyaluronic acid filler or surgery of the lower eyelids is the most appropriate treatment. Reasonable expectations must be established about what lower eyelid surgery can and cannot accomplish as with all plastic surgery procedures.
Trust Your Face to a Facial Plastic Surgeon
It is important to seek a fellowship-trained specialist in plastic surgery of the face and neck when you have concerns about age-related changes to your face and/or neck.
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