What are Tear Troughs?

What are Tear Troughs? 

The tear trough is the area between the lower eyelid and upper cheek. With age this area changes in appearance, becoming longer, deeper and developing a dark shadow that often makes us look older than we are. Tear trough filler treatment is an ideal way to improve the appearance of dark circles under the eyes.

This non-surgical treatment can help to reduce or even remove dark eye hollows that give the face that tired aged look. Tear trough fillers are safer and faster than cosmetic surgery, with virtually no downtime. The treatment is almost pain-free, and your client can be back at work almost instantly.

What results can be expected?

The tear trough dermal filler treatment normally takes approximately 25 minutes, firstly using local anaesthetic cream to numb the area prior to treatment. The results of the tear trough treatment are immediately visible once the dermal filler is administered, as this replaces lost volume to the under-eye area.

 How long does the tear trough filler treatment last?   The average duration of the effects of tear trough treatment using a dermal filler such as Teosyal Redensity 2, the only product that is licensed for use in this area, which lasts around 6 months. The Hyaluronic acid in the product is broken down gradually over time.


Candidates for Eye Hollow Treatment


Who is a candidate for correction of eye hollows? Appropriate client selection is vital, If your client is unhappy with the sunken, dark look under their eyes and want to turn back the clock to their youth, then tear trough filler treatment could be your answer for them.

Some clients have a pouch under the eye now if you can pick this skin up then the tear trough is not for them as they will fill with filler and just sit inside the pocket and make their eye worse. Avoid at all costs.

The picture below is an example of thetypes of eye bags which we do not treat with tear trough treatment.  This case is more appropriate for surgery – as you can see in these before & after pictures from lower blepharoplasty surgery.


This illustrates the clear difference between tear trough and eye bags. By pinching the skin slightly in the area, you will distinguish who you can and cannot treat.

When treating the tear trough, the safest way is to use a cannula.

Injection technique- for theoretical use only. Techniques are best observed during the practical element of your training

  • .    Circle the trough around following the orbital rim
  • .    Mark on the trough line below the pupil
  • .    Use a filler mixed with lidocaine if possible. Most fillers are now formulated with the lidocaine premixed.
  • .    Patients with very fair and thin skin may be better candidates for a filler that reduces the tyndall effect, such as Redensity II
  • .   Prior to injection you can also place a small ice pack on the lower lids. This will provide extra  anaesthesia and induces local vasoconstriction for less bruising.
  • .    To minimize bruising, use a blunt-tipped cannula instead of a needle for injecting the filler. The cannula should be long enough that the entire tear trough region can be filled with a single (38mm)
  • .   Make an entry point at the marking under the pupil below the tear trough line using a 25-27-gauge needle and a blunt-tipped 27- 30-gauge cannula for filler injection.
  • .    To minimize intravascular complications, use a retrograde injection technique (injecting product while withdrawing the needle) and slowly deliver the filler in numerous small aliquots. Micro-fanning thread injections were made with the cannula and continually massaged over the area
  • .    When injecting the tear trough region, inject along the inferior orbital rim in a pre-periosteal plane. After each injection pass, gently massage the area to evenly distribute the filler
  •    .Place filler deep to the suborbicular is oculi fat (SOOF). Given that the patient had good skin elasticity and thickness, the decision was made to inject filler in the subcutaneous layer above the orbicularis oculi muscle, over the tear trough deformity and the palpebral mallar groove
  • .    Don’t over inject, as most fillers cause some degree of edema. Check the patient two weeks later and assess for any areas that need a touch-up.




Although the most common complications are lumps, bumps, a blue hue from the Tyndall effect, and hypersensitivity reactions, some complications are more serious.

Swelling. Edema around the eye is a major complication, and it is not entirely clear why it develops. Some patients are susceptible to it, perhaps because they have pre-existing edema, and they may develop a little allergic swelling, or they happen to have hypothyroidism or heart disease or some systemic edema, and they tend to get fluid or chronic allergic swelling. These patients can develop even more of a boggy edema that can occur early or late after the injection.

CRAO. With dermal fillers in general, central retinal artery occlusion (CRAO) is the worst complication because it leads to permanent blindness. Although CRAO is very rare—believed to occur in only 1 in 10,000 injections—anyone who injects filler should keep this potential disaster in mind. Emergency kits are essential in all practices, and knowledge of emergency use of Hyaluronidase is essential

Although it sounds dramatic , there are numerous reports of blindness. For example, a recent case series described CRAO resulting from dermal filler injection to the forehead, and the Korean Retina Society reported on a retrospective study of 44 patients who developed occlusion of the ophthalmic artery or its branches after cosmetic facial filler injections. The authors of the latter study noted that “extreme caution and care should be taken during these injections.”

Most reported cases involve large boluses given within seconds. Patients experience sharp pain and lose vision immediately. It can happen with any filler, including fat, and in almost any area (glabella, nose, nasolabial folds). Recommendations are to inject slowly, don’t use a lot of force, and be aware of the patient’s response. “In the glabellar region (the highest risk area) stay superficial and away from the neurovascular bundles.

 Danger Zones

  3. NOSE


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