Top 10 Things a Patient Should Know Before Having Tear Trough Filler

Before and after tear troughs
Before and after tear trough fillers

What are the top ten things a patient should know prior to treatment of tear troughs?

 Is it safe? 

All medical procedures come with risks

Risks with filler injections in the tear troughs include:

  • Occlusion /blocking of blood vessels/blindness, stroke, death
  • Bruising is a collection of blood that has not escaped through the skin and lies beneath the skin.  Bruising can occur any time a needle is placed into the tissue (anywhere on the body; it is more noticeable with cosmetic injections as they are mostly in the face so we may have to disguise the bruising. Bruising in the eye area can linger for a couple of weeks, before it breaks down and get reabsorbed, starts as a blue/black bruise and fading to green/yellow.  Bromelain is a pineapple extract in a table form that can expedite this process
  • Swelling: With tear troughs, we choose to use a product suitable for the area. We choose fillers that are less water absorbing than other fillers so the product swelling is minimal. There could be swelling from the ‘trauma’ of the cannula or needle going in and out of the tissue.  It is advisable to do this treatment 2 weeks before any event in order to allow time for settling of any swelling or bruising.

Are the risks that are mentioned above immediately recognised?

In the case of a bruise, usually yes.  Occlusions may not be evident for a couple of days though it is more likely that we would recognise this immediately.

What happens when there is a blockage/occlusion?

We use an enzyme called hyaluronidase to dissolve the blockage.

Multiple treatments may be required in order to achieve the ideal trough depth for the patient

 Because of the delicate nature of the trough area it is preferable to only treat with 1ml at a time in order to prevent unslightly ‘sausages’ or swelling or Tindall effect – this is where the filler product is visible under the skin and throws a grey/blue tinge. 

Skin care and sunscreen is an absolute must when talking about cosmetic injections

If the ‘canvas’/skin is not clear then the tear trough filler results will be less than ideal. As we age, looking after the already thin skin around the eyes is important so that we have a good ‘envelope’ for any products we plan to use. Use of topical serums such as hyaluronic acid and use of sunscreen will stand one in good stead for ageing eye skin.

We also recommend skin treatments like skinbooster or PRP or RF microneedling.

Most people do not require what they think they need

An example of this is that most patients would benefit from a mid-face /cheek treatment to shorten their trough and support the cutaneous ligament that is visible in the midface when there is volume loss. There are some patients who say “I only want you to inject the trough, not the cheek”, when this is a very bad idea anatomically.

Everyone is different

Everyone is different anatomically. This applies to bone structure and volume loss, prolapse of fat under the eye.

The other area in which people are different, is their propensity to attract water to the under eye area.

Lifestyle matters

No sleep will make eyes look worse. Alcohol will dehydrate the skin, smoking will reduce the oxygenation of the blood supply and therefore delay healing times.

How long will the treatment last?

The studies demonstrate that the filler is designed to last, once injected, approx. 12months.  Some will find it lasts longer and others will find they need to retreat quicker. This is when activity and lifestyle matters can impact the longevity.

When can a patient have a second tear trough treatment?

We advise that patients will typically require 1-3 treatments. It is great to leave a minimum of 1 month between treatment to ensure that we have allowed for the settling of any bruising/swelling.

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