Thursday, March 15, 2012

Lower Eye Lid Aesthetics : Part 1 – Hyaluronic Acid Fillers to Correct Tear Trough

Tear trough refers to a fold extending from the inner eye corner running downwards and outwards that will look worse when a light is shined from above. The shadow created by this groove is commonly perceived as a dark eye circle. It's a safe bet that tear troughs can make anyone look more tired and older than they really are.

Diagram showing the tear trough, also known as nasojugal fold.

Causes Of Tear Trough

Tear troughs are caused by the lower eye lid skin tethered down to underlying structures by a ligament (the orbital malar ligament). Therefore, even very young people in their early twenties can have tear trough deformity. As we age, progressive soft tissue and bone loss in the lower eye lid area causes the tear trough to appear even deeper.

21-year-old “Twilight” star Kristen Steward seen here with “bags” under her eyes. These are not real eye bags but are actually tear troughs.

Tear troughs are different from eye bags, commonly found in older individuals. True eye bags are caused by the weakening of muscles and soft tissues supporting the lower eyelids due to aging. Fat tissues migrate forward and cause the appearance of puffy lower lids.

An aging patient with true eye bag and tear trough. The protruding lower eyelid fat may cause the tear trough to appear more visible.

Treatment Options
While tear troughs can be corrected surgically, hyaluronic acid filler as a non-invasive treatment option is gaining popularity due to its good safety profile and natural looking results. Hyaluronic acid fillers can be injected to restore loss volume and achieve a smooth contour of the lower eye lid area. In addition to erasing the tear trough, it can also diminish dark eye circles associated with tear trough.

Before hyaluronic acid filler injection (top photo), this young lady has tear troughs that are associated with dark eye circles.

After treatment (bottom photo), her tear troughs disappeared and dark eye circles lightened as if being erased by Photoshop.

How is the Procedure Like?

I normally choose a hyaluronic acid filler containing lidocaine (a local anaesthetic agent) to minimise any discomfort to the patient. The procedure can be completed in about 15 minutes and pain is minimal. Results are visible immediately and may last from 4 to 6 months, depending on the type of fillers used. 

Possible Side Effects

Lower eye lid swelling, bruising and lumpiness are a few common side effects. Swelling and bruising usually take a few days to subside. In order to minimise the risk of bruising it is advisable to discontinue the use of Aspirin or any anti-inflammatory medicines such as Indomethacin, Ibuprofen and Voltaren for at least 2 weeks before the produre (please discuss this with your doctor if in doubt). If a patient is unhappy with the results, the hyaluronic acid filler can also be dissolved with a small injection of Hyalase (an enzyme that breaks down hyaluronic acid).


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