Hyaluronic Acid (HA) fillers provide a minimally invasive way to enhance several areas of the face. These include the lips and cheeks. It is now more commonly used around the eyes. Specifically, it is applied in the tear trough area where many patients exhibit depressions or circles.
Filling in this area is different from other more forgiving areas due to the anatomic characteristics involved. The following guidelines ensure reproducible results in rejuvenating this area of the face.
Cannulas
The use of blunt fine cannulas reduces the risk of bruising in this area and also protects against possible intravascular injection of product that can lead to more serious complications
Type of Fillers
Less viscous HA fillers, like Belotero or Volbella, are preferred for this area. These are thin HA products. They help prevent nodule formation. The skin and subcutaneous tissue in this area is thin. Therefore, thicker products may lead to visible deformities. These deformities are then difficult to correct.
Placement and Injection Technique
Injection deep to the skin and orbicularis muscle is the preferred plane of injection. If the injection is done too superficially, there is not only the risk of nodules. There is also the risk of the Tyndall effect occurring in the area of injection. This happens when a bluish hue appears in the area of injection. It occurs due to light refraction through the skin and into an area of filler accumulation.
Injecting in a retrograde fashion helps limit the risk of complications like nodule formation and intravascular injection.
Complications
Serious injection complications can occur like intravascular injection and skin necrosis. If signs of this complication do occur, the use of hyaluronidase injection can help reverse these complications. It is important to have this available when doing injections in this area.
Summary
By following these principles when doing tear trough filler injections, you can achieve a safe filler session. This will ensure success in the lower eyelids. Please visit us at Thomassen Plastic Surgery to see how tear trough filler rejuvenation can improve your lower eyelid aesthetics.
Learn more about tear trough fillers and rejuvenation at the American Society of Plastic Surgery website.
References
Rao BK, Berger LE, Reilly C, Alamgir M, Galadari H. Tear trough filler technique utilizing hyaluronic acid: A systematic Review. Plas Reconstr Surg. 2022;149;1079-1087
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