Tear Trough and Cheek Fillers: Assessment is Everything

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Before and after tear trough fillers
Before and after tear trough fillers (also nose filler)

Tear Troughs and Injecting

The tear trough and whole lid cheek junction complex is an interesting area on the face for injectables. Tear trough injecting is an advanced technique and a high risk area for complications. The complications include aesthetic ones like, lumps and Tyndall effect, to catastrophic ones like blindness.

Patient concerns

Patients are very concerned about their eye bags, dark circles, hollowness and other issues.  Often it is an area that is commented on by others, “You look tired”, “Didn’t you get much sleep last night” etc. These types of comments can make patients focus on this area, even if it is not particularly problematic

Tear trough Ageing

As we age, with bone and soft tissue loss, our troughs get longer and deeper. The skin overlying gets finer and crepier and more sun damaged.

One of the keys to successful tear trough treatment is getting them looking natural and smooth.

Tear Trough Filler Pitfalls: Consider the Cheeks

Patients and new injectors often misunderstand where the defects are and how to get great results.

One of the most vital parts of tear trough treatments is to have an adequate cheek height and support below and near the junction.

Many patients have a concave or flat front cheek (like the model in this case study). This can contributes to the appearance of aged tear troughs, and can make the trough appear longer. The front cheek area must be corrected to have successful tear trough treatment. Front cheeks look optimal when they have a smooth transition from the lid to a gently convex (but NOT OVERPROJECTED) front cheek. An overprojected front cheek makes the patient look quite cosmetically deformed.

Before and after tear troughs fillers
This patient has a concaave front cheek contributing to her tear troughs. This must be addressed for a good result
Before and after tear troughs / cheek filler to help correct flat cheek profile
Before and after tear troughs / cheek filler to help correct flat cheek profile.
This patient also had non surgical rhinoplasty.

For patients with this anatomy, multiple treatments are often recommended and required.

It is difficult when a patient doesn’t understand this issue and says “I don’t want my cheeks filled, I only want my tear troughs corrected”. If an amateur injector listened to this request went ahead and only filled the upper “tear trough” section, the result would be aesthetically very very poor, potentially with lumps, inadequate correction and in general a very odd appearance. Patients must be educated on this issue.

Before and after cheek and tear trough fillers
Before and after cheek and tear trough fillers

The Importance of Gradual Improvement in the Area

Slow and steady, and getting the anatomy right wins the tear trough race. We usually advise a minimum of 3 treatments for all tear trough treatments. For those with concave cheeks, even more treatments and product may be required.

To start or correct your tear trough improvement journey, please call 93315005 and make an appointment to see our experienced doctors.

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