The tear trough is a groove that sits close to the nose between the lower eyelid and cheek. On occasion this may begin to show in young people in their 20s. Most of the time, it becomes more evident as we get older, and our face undergoes “aging changes”. This commonly includes loss of volume (fat) in the central cheek and more prominence of our eyelid “fat bags”. It can also be associated with more significant weight loss.
Its presence makes many of us feel like we look “tired” and older than we would care to look. The combination of the bulging eyelid fat and loss of fat in our cheeks give the illusion that our eyelid is longer vertically which is more consistent with aging. This is quite different from the lower eyelid of youth, which is short, lacks bulging fat and is supported by the cheek.
Why are my lower lids protruding fat now? We are fortunate to have fat around our eye. Like in other areas, fat is protective. As we age, the membrane that supports the fat becomes weakened resulting in bulging.
Why am I losing fat in my face? This is the balance of nature. Most of us are trying to lose fat on a regular basis. Losing a bit in the waist or hips is never an issue. When we lose it in our face, it deflates and ages our appearance. With the collapsing of our cheek due to volume loss, it also falls with gravity creating a deeper nasolabial fold (laugh line), marionette line and can even distort our jawline. The loss of fat in our central cheek exposes the underlying bone, both in cheek or malar area and along our eye socket (orbital rim).
Why filler? Injectable fillers can temporarily reverse some of these aging changes we described above, including the tear trough. Placing the filler in the tear trough area softens that transition between the lower lid and cheek, restoring a more youthful appearance. This helps camouflage our puffy eyelids and restores projection to our cheeks. It may help eliminate the darken, sunken area which we call the tear trough. The filler we use is made of hyaluronic acid and is completely reversible.
What is the best tear trough filler to use? We primarily use one of two products: Restylane L or Refyne and Vollure (Juvederm family). My recommendation depends on the color of the patient’s skin and what our goals are. These products in this area last somewhere between 9-12 months.
Does filler in this area hurt? Our team uses a topical anesthetic as well as ice to treat the tear trough. It is not painful for most of our patients. We use a cannula, which is a blunted small probe instead of a needle which we feel is more precise and less likely to cause bruising. It has been described as a “weird feeling” by some. I allow most patients to work out within 4 hours and get back to their normal routine. There will be some mild swelling that usually is resolved within 24 hours. Because there is a local anesthetic in the filler product, one may experience some “twitching” of the muscles in the area for an hour or so.
Is the procedure different in men? Men often lose more volume in the cheek in this area so at times, men may require a bit more product in the cheek and along the bone socket (orbital rim). Each patient is assessed, and the recommended treatment is specific for that patient.
Is filler in the tear trough dangerous? Like with any procedure, there may be complications associated with tear trough injections. The most common complications include temporary lumpiness and/or bruising. Patients can experience prolonged swelling in the area which may take longer than 24 hours to resolve. Fortunately, this is rare. Should a patient encounter lumpiness, this often can be improved with massage alone. The filler can also be dissolved should the patient be unhappy. Blindness is a very rare complication that has been reported with fillers injected in this area. This is due to filler getting into the blood stream. As mentioned, it is extremely rare.
Is tear trough filler for everyone? In some cases, the degree of bagginess to the lower eyelid and deflation and sagging of the cheek is more advanced. These patients may be better served with surgery to help create a more youthful eyelid and cheek.
In summary, fillers made from hyaluronic acid are excellent options for patients experiencing the presence of cheek deflation and tear trough deformities. It is an office procedure with a high success rate and quick recovery and is reversible if need be.
Contact us here for your consultation in Dallas or Frisco with Dr. Kenkel!
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