How to get the Best Results Injecting Tear Troughs

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
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

Here our injector discusses the top tips for getting the best results for tear trough filler.

Understanding the Anatomy

Understanding the tear trough anatomy is key to treat the area well. Some patients are simply not good candidates for the procedure and might need a surgical intervention such as lower blepharoplasty with fat repositioning or fat grafting.

What Type of Tear Troughs does the patient have

It’s important to analyze well what type of tear trough the patient has. Is it treatable with dermal filler?

Class I tear trough:

Patients who present with nil orbital fat bulging without excess of the lower eyelid skin. This class can be treated with dermal fillers and might require a combination of cheek and tear trough treatment.

Class II tear trough:

Patients who present mild to moderate orbital fat bulging without excess of the lower eyelid skin.

Normally those patients also present flatness of midface. Treatment with dermal fillers is possible but treating their cheeks is essential for a correct approach.

Class III tear trough:

Patients who present with a considerable volume loss in the area, fat bulging and excessive lower eyelid skin.

Patients who present this type of tear trough deformity are generally not the best candidates for an improvement of the area with dermal fillers.

Avoid the Tyndall effect

The Tyndall effect is a bluish tone visible through the skin when the filler product is placed too superficially or in large boluses.

It might be mistaken for a deep bruise.

It’s more likely to occur in older patients where thinning of skin is more evident, or with younger patients who have fine skin.

The best way to avoid the tyndall effect is to:

  • Refrain from treating patients that have compromised and thin skin;
  • inject the area at the periosteal level or in the suborbicularis plane;
  • inject only very small aliquots and never use large boluses in the area;
  • massage the area firmly to flatten any excessive or superficial filler placed.

Plan and execute tear trough fillers in 2 to 3 sessions

Performing injections in the tear troughs with smaller amounts through the course of multiple sessions 4 weeks apart helps to prevent overfilling the area.

Plan for periorbital skin rejuvenation

Treating the periorbital skin is key to achieve satisfactory results. Many patients that have the tear trough as their main concern also have crepey thinning skin.

Options for skin rejuvenation in the eye area

The following treatments are fantastic to improve the skin condition around the eyes

  • Ablative laser, including fractionated or full field resurfacing
  • RF microneedling
  • Skinboosters
  • PRP
  • At hom skincare

Don’t undertreat their cheeks if they need correction in the area.

Undertreating the cheeks is one of the main reasons why patients present a poor result after tear trough fillers. Many patients will require a minimum of 3 mls or more of dermal fillers injected into their cheeks before having a tear trough procedure.

Avoid performing tear trough fillers in patients with seasonal allergies.

Patients that have seasonal allergies normally present redness, itching, tearing and swelling of the eyes. As hyaluronic fillers are hydrophilic and can absorb up to 10 times their volume, having them can significantly worsen seasonal allergies symptoms. The swelling of eyes can last for weeks, even months sometimes and that can worsen skin laxity conditions.

Any patient with a history of water attracting under the eyes is a poor candidate. These patients will give a history of noticeable variability of their under eyes. Eg they may have more swelling when they wake up or some days their eyes will look much worse than normal

Don’t forget to use skinbooster under the eyes

Skinbooster is a really important weapon in the treatment of the under eye area and is really subtle and gives a great result when used alone or in combination with dermal fillers under the eyes. The improve skin quality and create a smoother look.

Can dermal fillers improve the darkness under the eyes?

If the patient has a class I or class II tear trough type and presents dark circles as one of the concerns, having tear trough filler can definitely change how light shines off, improving the darkness in the area. It`s important to combine laser, chemical peels and skinceuticals to create a more significant enhancement.

Please see some before and after images of tear troughs by The Manse, Sydney