Tear Trough

Treating the Tear Trough
William Shakespeare once said that the ‘eyes are the window to the soul’, and if he is to be correct, then you’re going to want to make sure they’ve not lost their sparkle.

Feb 17th, 2021

But it’s not the actual ‘eye’ itself that’s usual of concern, but rather the area around it – more specifically, the tear trough.

A tear trough can be defined as a deep crease between the lower eyelid and upper cheek. It can appear sunken and hollow and this can cause a dark appearance, making the eye area look tired.

Sometimes, people are genetically pre-disposed to a tear trough deformity, for others it’s a natural part of ageing.

All under-eye issues are the tear trough, right?

No.

The tear trough is under the eye, but it doesn’t account for all under eye concerns. There is a lot of confusion as to what the tear trough actually is, and just because you’re seeing dark circles doesn’t mean it’s caused by a tear trough deformity.

A tear trough can be defined as a deep crease between the lower eyelid and upper cheek. It can appear sunken and hollow and this can cause a dark appearance, making the eye area look tired.

Sometimes, people are genetically pre-disposed to a tear trough deformity, for others it’s a natural part of ageing.

Dermal filler treatment

When treating patients for a tear trough deformity I use dermal filler Teosyal Redensity II as it is the only licensed product for the delicate tear trough area. This filler was used in the following three case studies.

Case Study 1: Tired eyes with under eye darkness

Patient in his 30s, with successful career on stage and loads of followers.  He felt he was constantly looking drained, ill as if he was having an unhealthy lifestyle which he felt it was giving to his audience the wrong message.  But this look also had a negative impact on him.  He was VERY hesitant to have fillers thinking this will change the way he looks. Eventually he was convinced that I was planning to tweak the affected area rather than treated him. And the outcome was great.
Case 1a
Case 1b
Case 1c

There are many factors that can be the cause of under eye darkness, such as:

  • Anatomy – there are no fat pads in this area meaning it is more concave.
  • Hereditary – quite often genetics are the cause and tear troughs can be seen even in children
  • Accidents – any trauma to the eye or surrounding area, including nose operations
  • Hormonal – pigmentation can be caused due to hormones and can be seen during pregnancy and menopause
  • Constricted blood vessels – as they dilate, they become darker, pigmenting the under eye

Although many patients complain of darkness, it’s not the pigment as such that we are correcting to improve the aesthetic, instead we are treating the hollow to make the area more convex and therefore less dark.

Case Study 2: Volume loss

This patient was doing everything right. Young, ambitious, dynamic, healthy and getting plenty of sleep; this patient was already taking good care of her skin and following medical skincare regimes. Yet, despite her best efforts, she was losing the battle against under eye darkness.

She came to the clinic wanting to improve her under eye darkness before a job interview. She felt she could compromise the outcome of the interview if she presented herself looking tired and unhealthy due to her eyes. Her eyes were telling the very opposite to how she felt. "I have to look fresher," is what she said. As in the case above, it was volume loss causing the dark pigment.

This tear trough hollowness was due to combined volume loss from not just the tear trough, but the palpebromalar groove and mediojugal fold. Restoring only the tear trough volume loss would have caused a poor outcome. Therefore, the surrounding areas were also treated, leading to a great result for the patient.

Case Study 3: A Complex Case

This case was a little bit more complex. The patient presented with a Type IV tear trough, where the hollowness is combined with the presence of malar bags (swollen / puffy eye bags). The under-eye area was making her look a lot older than what she is. In most cases, patients need to be referred to a plastic surgeon as this is the only way to completely remove the bags. However, this patient was not ready for surgery. After careful evaluation, it was decided we could still help this patient and improve the under eye. However, caution had to be taken to ensure filler was not placed into the wrong plane/area otherwise the eye bags could be exacerbated.

Careful replacement of volume loss from the surrounding areas meant we could lift up the deep hollowness under the bags, giving the illusion the bags had been removed.

tear trough treatment
tear trough treatment
tear trough treatment

It should be pointed out that tear trough fillers are not a treatment for under eye bags and most of these cases need to be referred to a surgeon.

Are tear trough fillers right for me?

Under-eye filler treatment is not suitable for all individuals as more severe cases may require surgery. However, if you have a mild to moderate tear trough deformity then this treatment could indeed help improve your overall aesthetic.

We always provide patients with a full consultation to find the right treatment for their concerns.

For more information on how to tackle the sensitive under-eye area visit our Refresh and Revitalise signature package exclusively designed for periorbital rejuvenation.

For more tear trough cases visit our Instagram

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