Tear Trough Filler (Under Eye Filler)

Tear trough filler, or under eye filler, is a commonly performed anti-ageing treatment at Centre for Surgery in London.

There are several alternative names for tear trough fillers, including:

1. Tear trough injections
2. Under-eye fillers
3. Eye bag fillers
4. Non-surgical eye lift
5. Non-surgical tear trough treatment
6. Tear trough augmentation
7. Tear trough correction
8. Under-eye rejuvenation
9. Under-eye restoration
10. Under-eye volumisation.

The tear trough area is the inner part of the lower eyelid and is also known as the nasojugal groove. With ageing, the amount of fat gradually decreases in the lower eyelid and adjacent upper cheek region. A loss of collagen and elastin cause the skin and muscles in the lower eyelid to lose their underlying structural support. Eventually, the changes caused by the loosening of the soft tissue attachments cause the tear trough area to become swollen and appear protruding. With prolapse of the underlying tissues, the formation of eye bags occurs. Dark shadows develop, and these can give rise to the appearance of dark circles under the eyes. Despite the use of make-up, the face can still appear tired. Using dermal fillers to rejuvenate the tear trough region is a highly effective treatment for facial rejuvenation in both men and women.

What is Tear Trough Deformity

Tear trough deformity, also known as under-eye hollows, is a common cosmetic concern characterised by a hollow, sunken appearance under the eyes. It is caused by a loss of volume and thinning of the skin and soft tissues in the under-eye area, resulting in a depression or groove that extends from the inner corner of the eye to the mid-cheek.

RELATED: Sunken Eyes – Causes & Treatments

Tear trough deformity can be genetic or age-related, and it can affect individuals of all ages and skin types. It can make a person look tired, haggard, or older than their actual age, even if they are well-rested and healthy.

While tear trough deformity can be challenging to treat, there are several non-surgical options available, such as tear trough filler injections. The filler is injected into the under-eye area to add volume and fill in the hollows, resulting in a smoother and more youthful appearance.

In addition to filler injections, other non-surgical options for tear trough deformity include chemical peels, laser resurfacing, and microneedling. However, these treatments may not be as effective as filler injections and may require multiple sessions to achieve optimal results.

For severe cases of tear trough deformity, lower blepharoplasty, a surgical procedure to remove excess skin and fat from the lower eyelids, may be necessary to achieve the desired results. It’s essential to consult with an experienced and qualified plastic surgeon to determine the best treatment option for your specific needs and concerns.

Expected Results after Tear Trough Injections

• Reduced appearance of dark circles under the eyes
• Reduced hollow appearance beneath the eyes
• Reduced appearance of eye bags
• A more refreshed and revitalised appearance

Tear trough deformity refers to a sunken, hollow appearance under the eyes that can make a person look tired or older. The following are some of the common causes of tear trough deformity:

1. Ageing: As we age, the skin and soft tissues around the eyes start to lose elasticity and volume, making the tear trough area appear hollow and sunken.
2. Genetics: Some people are born with a predisposition to a deep tear trough, which can become more pronounced as they age.
3. Sun damage: Prolonged exposure to the sun can damage the skin and lead to the development of wrinkles, fine lines, and a hollow tear trough.
4. Weight loss: Rapid weight loss or fluctuations in weight can cause loss of volume in the face, including the tear trough area.
5. Poor diet and lifestyle factors: A poor diet, lack of sleep, dehydration, and stress can all contribute to the formation of a tear trough deformity.
6. Medical conditions: Certain medical conditions, such as allergies, sinus problems, or thyroid issues, can also cause the tear trough area to become more pronounced.
7. Anatomical factors: Some individuals have an anatomical predisposition to a deep tear trough due to the shape of their skull and facial bones.

Tear trough fillers have become a popular non-surgical cosmetic treatment for addressing dark circles and bags under the eyes. Some of the key benefits of tear trough fillers include:

• Improved Appearance: One of the most significant benefits of tear trough fillers is that they can dramatically improve the appearance of dark circles and bags under the eyes. By filling in the hollows and reducing the shadows, tear trough fillers can create a more refreshed and youthful look.
• Non-Surgical: Tear trough fillers are a non-surgical treatment, meaning that they don’t require incisions or general anaesthesia. This means that there is minimal downtime and patients can resume normal activities immediately after treatment.
• Quick Procedure: The tear trough filler treatment is typically a quick procedure that can be completed in less than an hour. Most patients are in and out of the clinic within 30 minutes.
• Long-Lasting Results: The results of tear trough fillers can last up to 12-18 months. This means that patients can enjoy their refreshed appearance for an extended period without needing additional treatments.
• Minimal Side Effects: Tear trough fillers have minimal side effects, which usually include mild swelling or bruising at the injection site. These side effects are temporary and generally resolve within a few days.
• Customisable Treatment: Each patient’s tear trough area is unique, and the treatment can be tailored to meet each individual’s specific needs. This means that the practitioner can customize the filler type, amount, and placement to achieve the best possible results for each patient.

RELATED: Why Under Eye Filler is Not For Everyone

The tear trough area is considered to be a challenging area to treat because of its complex anatomy and the delicate nature of the skin in this region. Here are some reasons why:

1. Thin skin: The skin around the eyes is thin and delicate, which makes it more susceptible to bruising, swelling, and other complications associated with filler injections.
2. Complex anatomy: The tear trough area is complex, with numerous blood vessels and nerves that must be carefully avoided during injections. Additionally, the area is located near the eye, which means there is little room for error.
3. Volume loss: The tear trough area often requires a subtle and nuanced approach, as overfilling the area can lead to a puffy, unnatural appearance. The aim is to restore volume to the area while maintaining a natural look.
4. High risk of complications: The tear trough area is at a high risk of complications such as lumpiness, overcorrection, and migration of the filler. To minimize these risks, it is important to choose a skilled and experienced injector who understands the unique challenges associated with treating the tear trough area.
5. Limited efficacy of other treatments: In some cases, alternative treatments such as creams or serums may not be effective in addressing tear trough deformity. Tear trough fillers are often the best option for correcting this issue and achieving natural-looking results.

• Patients with moderate degrees of hollowness under the eyes. A lower blepharoplasty or eye bag removal procedure may be more suitable for those with severe hollowing of the lower eye area.
• Patients who would like to reduce the appearance of prominent dark circles beneath the eyes
• Patients who germ constantly reminded by family and friends that they look permanently tired or that they are not getting enough sleep
• Patients who do not take any medications that can increase the risk of bleeding, such as aspirin or medicines containing aspirin

Tear trough filler Vs lower blepharoplasty

Tear trough filler, despite its great effectiveness for mild to moderate degrees of hollowness, is not ideal for those with more severe degrees of tear trough deformity. In these cases, a surgical lower blepharoplasty or eye bag removal procedure may be more appropriate. Lower blepharoplasty is particularly effective for patients with significant soft tissue laxity of the lower eyelids and/or the lower eyelid muscles. The presence of festoons is also an indication for lower blepharoplasty. Festoons are well-defined pouches of skin that protrude in the cheek area underneath the lower eyelid and are related to the ageing process. The use of tear trough filler in this scenario would be ineffective, hence why we would always recommend seeing a fully qualified plastic surgeon who can perform all under eye treatments.

Under eye filler before and after:

The key to eye filler treatment is to be conservative with treatment and never to over-inject. It is always best to be seen two weeks later for a top-up treatment if required. Our protocol for all filler injections is to see all patients two weeks later for a clinical assessment of treatment effectiveness.

The success of tear trough injections relies on the patient being properly prepared for the procedure in the weeks beforehand. Before the procedure, you will be required to stop certain products and medications and also reduce intake of certain foods that are high in alpha-omega 3.

Two weeks before tear trough injection

Patients should avoid fish, fish oil nuts or seeds or NSAIDS such as ibuprofen which have been shown to increase the risk of bleeding. Arnica tablets are very useful to help with reducing any post-injection bruising. Arnica tablets can be purchased over the counter from most pharmacies. If you are on any prescription medicines which are known to increase the risk of bleeding, then these may need to be stopped before treatment. It is very important to speak with your GP before stopping any medicines and also to receive instruction on the best time to restart the medication. Patients on medicines which are vital for health should not stop their medicines under any circumstances. In this instance, having a tear trough filler procedure may not be appropriate. Patients with a history of cold sores will need to commence a preventive course of acyclovir before treatment. This is to ensure there is no flare-up of herpes virus infection. Your doctor will be able to prescribe this for you before treatment. Finally, it is very important to read and understand the treatment consent form so you are fully familiar with the benefits, risks and complications associated with tear trough filler treatment.

On the day of your tear trough injection procedure

Please make sure to eat a light meal before your tear trough injections. This helps to raise blood sugar and minimise the risk of fainting during treatment. Many people are understandably apprehensive about needle injections, which is amplified by not having eaten or drunk before your treatment.

Please refrain from wearing any make-up before dermal filler treatment on the areas planned for treatment. Your practitioner must remove any makeup from the treatment area before your procedure. You can bring a light make-up product to apply for camouflage immediately after the filler treatment.

Please aim to arrive 30 minutes before your allocated appointment to enable the application of local anaesthetic numbing cream to the lower eye area. Local anaesthetic numbing cream needs at least 20-30 mins to achieve its full effect. This is why we ask patients to arrive a little earlier than usual.

Before you leave your appointment, we would advise booking your next appointment. This ensures you get your favoured timing, as our practitioners often get booked up to three months in advance. We always ensure never to double book patients for any injectable facial procedure, including tear trough fillers.

The area of skin between the upper cheek and lower eyelid is the recessed area known as the tear trough. The tear trough extends laterally and downwards into the cheek region. The ageing process results in tear troughs that become more prominent in both depth and width. The colour also changes to a darker shade. The expert placement of very small and targeted dermal filler containing hyaluronic acid in the tear trough area can lead to a smoothening of the tear trough deformity, and this gives rise to a more rejuvenated and youthful appearance.

Which are the best types of dermal fillers for tear trough correction?

The optimum hyaluronic acid (HA) dermal filler for tear trough correction is dependent on several factors, including Fitzpatrick skin type, type of tear trough deformity and skin thickness and texture. Many of our dermatologists and plastic surgeons prefer to use Juvederm Volbella, which is based on advanced Vycross technology, and this is responsible for the uniform smoothness of the Volbella product, which facilitates very accurate tear trough filler injections leading to more natural results compared with other commonly used brands. Compared with Juvederm Ultra, Juvederm Volbella absorbs much less water, allowing for a more effective tear trough correction without the risk of excessive under-eye swelling.

Sharp needle or blunt cannula for tear trough filler injection?

Blunt cannulas for tear trough correction differ from sharp needles in that the end of the cannula is rounded and blunt to the touch. Blunt cannulas are often preferred for many tear trough filler treatments as there is a reduced risk of the blunt cannula piercing a blood vessel leading to a possible risk of inadvertent intravascular injection. Avoiding injuring blood vessels means there is a lower chance of bleeding and bruising and less chance of complications arising from injecting fillers in blood vessels, including the risk of tissue necrosis and, in very rare cases, blindness. The use of precision-designed cannulas for tear trough correction allows injectors to reduce the number of times the skin has to be entered, making for a much more comfortable treatment and potentially smoother-looking results.

Benefits of blunt cannula injection technique for tear trough filler

1. Reduced risk of bleeding and bruising
2. Less treatment discomfort due to fewer cannula entry points compared with the sharp needle technique
3. Reduced risk of intravascular injection causing tissue necrosis and even blindness
4. A much quicker recovery thanks to the advanced atraumatic cannula design making for more gentle injections

Despite the excellent safety profile associated with the blunt cannula tear trough filler technique, the traditional sharp needle method for filler placement is still used when extremely precise injections of smaller amounts of filler are required. In many patients with milder degrees of tear trough deformity, smaller amounts of filler using a sharp needle will prevent potential overfilling, which may occur with the blunt cannula method. Other applications for the sharp needle technique include the treatment of acne scars and the treatment of the upper lip to create the Cupid’s bow. The micro-droplet technique is an advanced method of filler placement only performed by highly experienced dermatologists and plastic surgeons for hyper-accurate delivery of under-eye filler and is commonly used at Centre for Surgery for tear trough correction. We would recommend a face-to-face consultation with an advanced injector expert to determine the best type of injection technique.

With tear trough treatment at Centre for surgery, it is quite normal to have some localised bruising, swelling and some pinpoint bleeding from the needle entry points. If you had numbing cream applied, then this usually takes 2-3 hours to wear off. You can improve the healing process by following all the post-procedure instructions given to you by your doctor.

Top tips for optimum recovery after tear trough fillers

• Use cold packs gently applied against the treated area for approximately 15 minutes on and 15 minutes off. This should ideally be continued for the first 48 hours after treatment.
• Any strenuous exercise should be avoided for 48 hours to reduce bruising and swelling.
• Do not massage or manipulate your face in any way after treatment. Facials or scrubbing of the face should be avoided for one week after treatment to avoid filler migration. Gentle face washing is allowed.
• Light make-up and/or concealer can be applied immediately after your treatment to reduce the appearance of bruising on the skin.
• Do take arnica tablets to accelerate the disappearance of bruising.
• Pineapples and pineapple juice have been shown to reduce swelling, so it is recommended to have pineapples after treatment.
• Avoid overanalysing your face for the first couple of weeks after treatment. It is very normal to have bruising, swelling and a degree of asymmetry often due to swelling. Your surgeon always recommends waiting two weeks before the final results can appear.
• If you have any pain or discomfort in the treated areas, taking paracetamol is recommended to help with the post-injection pain. NSAIDS such as ibuprofen must be avoided as these increase the risk of prolonged bruising due to their action on blood platelets.

How long do dermal fillers for tear trough correction last?

Hyaluronic acid can last up to 18 months when injected into areas such as the nose or cheeks. Dermal filler effects can appear to reduce after a shorter period. In more mobile and dynamic areas of the face, such as the lips, where muscular contraction and movement are frequent, dermal fillers last a much shorter period. Dermal fillers in areas like the tear troughs or nose can last much longer – often over one year, depending on the type of filler used.

Common and expected side effects of tear trough injections:

Bruising

Bruising can last up to 2 weeks post-injection but can sometimes be as long as four weeks in patients with an underlying defect in blood clotting. Bruising can be covered with concealer. Injection of the tear troughs may result in more bruising than usual, as this is known to be a highly vascular part of the face.

Swelling

It is not uncommon to have swelling that is not equal on both sides of the face, as different patients may have degrees of pre-existing facial asymmetry and the amount of filler injected. The swelling usually takes up to 2 weeks to resolve. The patient should sleep in a raised position on two pillows to speed the resolution of swelling. All patients should avoid the gym for the first few days to avoid further swelling. Avoid massage of the treated area to avoid further swelling and possible migration of tear trough filler.

Asymmetry

Facial asymmetry is often related to post-treatment swelling. Patients should wait a full two weeks before an assessment on whether asymmetry is persistent and, if so, it is related to differences in volumes injected. Try to avoid over-analysing your face. It is not uncommon to identify new perceived differences in facial asymmetry after dermal filler treatment that were always there, to begin with.

Lumps and bumps

Injections of filler will result in a tissue consistency that will feel harder than your skin. You must avoid massage of the area to prevent migration of filler. Any feeling of lumps and bumps usually resolves in 2 weeks as the swelling subsides.

Subtle results

A typical 1ml syringe of dermal filler is roughly equivalent to 1/4 of a teaspoon in volume. After the resolution of tissue swelling, it may become apparent that more filler injection is required if your objective is increased volume. Our specialist facial plastic surgeons and dermatologists take great care to avoid overfilling the tear trough with large volumes at the outset. This is a guaranteed recipe for treatment failure. The optimum approach is always to add volume incrementally with time to achieve the optimum result. If you are new to tear trough dermal fillers, it is often the case that the results will last for a shorter period initially. However, with regular maintenance treatment, the results will be for longer as your body begins to generate its own natural collagen in the treated areas.

Possible complications of dermal fillers

• Granuloma formation
• Hypersensitivity reaction
• Allergic reaction
• Herpes virus reactivation
• Acne recurrence
• Skin necrosis from filler injection into a blood vessel
• Extremely rarely – blindness from injection into the glabella or frown region
• Infection and abscess formation

If you experience any of the above listed complications, please be sure to contact your surgeon immediately for an urgent assessment.

Centre for Surgery is an excellent choice for tear trough fillers for several reasons:

1. Highly Skilled Practitioners: At Centre for Surgery, you will be treated by experienced and highly trained practitioners who specialise in tear trough fillers. Our practitioners use advanced techniques and top-quality fillers to achieve the best possible results for our patients.
2. Comprehensive Consultation: Before any treatment is performed, our practitioners will conduct a thorough consultation to understand your individual concerns and expectations. This will allow them to develop a customized treatment plan that is tailored to your specific needs and goals.
3. Safe and Effective Procedures: We use only the safest and most effective filler products for tear trough treatments. Our practitioners use precise injection techniques to ensure optimal results with minimal downtime.
4. Exceptional Patient Care: At Centre for Surgery, we prioritize patient comfort and satisfaction. Our practitioners provide compassionate and attentive care to ensure that our patients have a comfortable and positive experience.
5. Positive Reviews: Centre for Surgery has received many positive reviews from satisfied patients who have had tear trough fillers and other cosmetic treatments. Our patients have praised our practitioners for their expertise, professionalism, and exceptional results.