Tear Trough Fillers

Tear Trough Fillers

Tear trough fillers can be used to improve the appearance of the under eye area. Tear troughs are depressions starting from the inner eye and moving outwards and downwards towards the cheek. The “lateral tear troughs” are their mirror image that start from the outside corner of the eye and travel downwards and inwards from that point.

Many patients are concerned about their under eye area, even from a very early age, and this concern intensifies over time. They can be concerned about the dark circles and shadowing under the eyes, the hollowing under the eye, or pockets of fat under the eye).

Dermal filler can be used to address these issues.

Dermal filler can be used in tear troughs to reduce the appearance of eye bags or under eye hollowness. It is a very common treatment in our Sydney clinic

Before and after 3 treatment with dermal filler injected into tear troughs. As so often with tear troughs, I am not 100% happy as there is asymmetry and I feel the result isn’t perfect. However, the patient is delighted and feels that the tear trough

Before and after dermal filler in tear troughs, further treatment will achieve an even better result

After 2 treatments dermal filler tear troughs. This was a difficult case. I was worried that there might be a touch of Tyndall effect after the first 2 treatments, but see images below which are after 3 treatments, results improved

This is the same patient as above. However, the after photo is 2 years and 5 months after the before photo (3 treatments of 1 ml were performed originally)

Before and after dermal filler injections for tear troughs (patient also had anti wrinkle injections)

Filler injections for tear troughs

Choosing the type of dermal filler for the tear troughs

At our clinic we will only use dermal fillers for the tear troughs that are as safety. I use the product that has good lifting capability and attract the least amount of water. We also may use the fillers that are most smooth and have the least potential to tear trough filler lumpiness

Dose for tear trough fillers

The dose required for tear trough filler is variable, it depends on the  patient’s anatomy, and where the patient wants to get to in terms of results.

The doctor will assess the tear troughs and decide on the best dose after taking a history and examining the patient. If a patient has a history of complications with dermal fillers, or if their budget is small or if they want a more subtle result, then a smaller dose might be chosen to start with.

We use a standard protocol for dermal filler treatment of the tear trough, which is

Treatment 1: 1ml dermal filler

Treatment 2: 4 weeks after treatment 1, 1ml dermal filler

Treatment 3: 4 weeks after treatment 2, 1ml dermal filler

Yearly treatments thereafter.

We often suggest other treatment modalities which work well to improve the results of dermal fillers in the tear troughs. The better the skin for tear trough fillers to sit under, the better the results of the tear trough fillers. We often recommend skinbooster, troughbooster, PRP, fractional laser resurfacing and needling to get the under eye skin in tip top condition so that we can achieve the best results with the tear trough fillers.

When injecting the tear trough and under eye area, it is necessary to inject multiple areas to obtain the best results, and we also prefer to inject over 3 sessions to avoid the very common negative results of tear trough treatment, which include lumps and blue appearance (Tyndall Effect).

Pain relief during treatment

A numbing cream (eg EMLA or LMX ) may be applied to the area prior to the treatment (45 minutes prior is ideal) Glad wrap may be used over the numbing cream to increase its effect.

If a cannula is used, local anaesthetic may used prior to the cannula being introduced into the skin. Cannula may be used in the first treatment, but for greater precision, needles may be used in treatment 2 and 3.

There is local anaesthetic in the dermal filler

Ice is always used to decrease pain and to reduce the risk of bruising.

Nitrous oxide (happy gas) is available for patients to use for tear trough injections

What happens during the injectables tear trough treatment itself?

The area will be cleaned with alcohol and chlorhexide to help prevent infections

Ice may be applied to the area briefly before treatment The doctor will inject using a needle. Then pressure with gauze will be applied.

If a cannula is used, a small injection of local anaesthetic may be injected into the skin and then a needle makes a small hole in the skin where the cannula is inserted.

How will I look after dermal filler in the tear troughs?

There may be redness and swelling, and red dots at the injection sites. Bruising is very common with dermal filler injection in tear troughs.

If cannula is used, bruising is less common.

Side effects /risks with dermal fillers in the tear troughs:

Bruising: occurs in a significant number of cases.

Swelling: in the injection area will occur. This will last for aprox 48 hours

Tyndall Effect:Blue appearance of the dermal filler under the skin

Lumps: Our 3 session technique reduces the incidence of lumps

Asymmetry: Sometimes one side is better treated than the other, this is usually because the patient is asymmetrical to start with.

Infection: is a very rare complication, but always a possibility when the needle goes into the skin.

Necrosis: (blood vessel being blocked, interfering with blood supply to the skin) is very rare. This could lead to scarring. The nose is susceptible to necrosis

Need for further treatmentIt may  take several syringes of product to get to where the patient wants to be.

Blindness: This should be discussed as there have been cases of it around the world

After Tear Trough Fillers

Instructions for care after treatment

No makeup for 4 hours

No heavy exercise that day

No acid face products for 24 hours

No spas no saunas, no hot yoga for 1 week post treatment

What to expect after the tear trough dermal filler  treatment?

The effect of the dermal filler will be obvious immediately

Most of the swelling from the dermal filler will have resolved by 2-3 days after the procedure. There may be a small amount of swelling for even 2-4 weeks after the procedure.

Bruising will last 7-8 days

What if I get asymmetry at some time before the 4 week point?

Tear troughs are often asymmetrical to start with and your doctor will do their best to work on this. In the early stages after treatment, sometimes asymmetry will occur because one side is more swollen or bruised. Usually it will right itself by the time of the review appointment. If it doesn’t, then it can be examined at the review appointment. There is no point in coming in early for treatment of asymmetry as there is often swelling associated and so the final result cannot be seen until at least 4 weeks. Treating asymmetry too early could lead to further asymmetry. Further treatment may be required to improve asymmetries

How long will the treatment last?

The answer to this is very individual and depends on the patient’s anatomy, metabolism, the dose, the placement, the product etc.

With the dermal filler  that we use, the protocol is 3 treatments, 1 month apart then yearly treatments

Cost of dermal filler in tear troughs

Cost is per syringe. Our most commonly used dermal filler for tear trough cost is $720 per ml. 1ml is used per session

For further information please see the following blog posts or use the search function on the website

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