The tear trough gives a tired appearance to the eyes and is bothersome to many patients that have them. They occur as a result of volume loss with aging although some people have them naturally. There are a variety of improvement strategies including injecting them with fat or synthetic fillers or using tear trough implants.
The simplest approach is to use synthetic fillers which can be precisely placed without the need for surgery. While tear trough treatment is associated with the highest rate of bruising of all facial areas treated with injectable fillers, its simplicity usually makes it worth the risk.
While there are many types of injectable fillers, tear trough injections should only be done with hyaluronic-acid based compositions such as Restylane or Juvaderm. Their soft gel consistency makes them ideal for the thin skin of the eyelids and the least likely to have irregularities and lumpiness. How long such fillers will last in the tear trough has not been clinically studied as data has never been collected for any formal FDA study submission. (nor will it likely ever be)
In making an assessment of how an injectable filler will last in the tear trough, a paper was published on this very topic in the May 2010 issue of the journal Plastic and Reconstructive Surgery. Ten patients were studied for over a year after Restylane injections to the tear troughs. They used on average just over 0.2cc per side. The effect was felt to be significantly maintained at a volume of 85% after one year.
Unlike other facial areas, hyaluronic injections to the tear trough last much longer. This is likely related to the lack of significant motion at this area unlike that of the lips or nasolabial fold. The authors of this study placed the filler not just under the skin but deep to the orbicularis muscle. This may also contribute to its lasting effect. While many injectors place the filler just under the skin, that is a mistake as it is much more difficult to get a smooth correction and the risk of bruising is higher.
Given the ease of tear trough improvement with injectable fillers, this should always be the first approach if no other periorbital surgery is planned. If Restylane can create a tear trough effect that is 3X more long lasting than other facial areas, this would suggest that other hyaluronic fillers will last even longer.
Dr. Barry Eppley
Indianapolis, Indiana