Treatment of the tear trough has become quite common since it has been recognized as an aesthetic deformity. A sunken in appearance in the inner aspect of the lower eyelid creates an indentation or trough that creates a shadow and the appearance of being tired or older. Its treatment has become popularized due to the use of injectable fillers. They offer a simple and usually very effective solution for tear troughs by adding volume to the depressed afrea
But even very successful tear trough treatments with injectable fillers is not a permanent solution. While hyaluronic acid based fillers do persist for a year or longer along the orbital rim, they will eventually be resorbed. Fat injections to the tear troughs may offer the potential for longer and maybe even a permanent solution but their take and survival is never a sure thing.
Another approach that offers a permanent solution is that of tear trough implants. Designed to be a bony augmentation implant to fill in the suborbital groove, it is placed through a lower eyelid incision. This makes it a good solution if one is having a lower blepharoplasty or is having other facial augmentations such as cheek implants. While they can be placed as an onlay in a soft tissue pocket, I prefer to secure their position using a small self-tapping 1.5mm screw. It is important to set the the screw into the implant so there is no possibility that it can be felt through the thin lower eyelid tissues.
Tear trough or suborbital implants offer a permanent solution to a recessed orbital rim in the inner half of the lower eyelid. For now such implants need to be placed through a lower eyelid incision. Future developments may allow a tear trough implant to be placed through an intraoral approach
Dr. Barry Eppley
Indianapolis, Indiana