Is the Treatment of the Tear Trough Deformity with Hyaluronic Acid Injections a Safe Procedure? A Systematic Review

Salvatore D’Amato,Samuel Staglianò,Romolo Fragola,Pierfrancesco Bove,Paolo Gennaro,Giorgio Lo Giudice,Rita Vitagliano

doi:10.3390/app112311489

Salvatore D’Amato, Samuel Staglianò + Show 5 more

Open Access

https://doi.org/10.3390/app112311489

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Abstract

Among the various therapeutic options for the treatment of tear trough deformities, the use of hyaluronic acid-based fillers has constantly been increasing. The aim of this research is to conduct a systematic review of the published literature related to the use of hyaluronic acid-based dermal fillers for the treatment of tear trough deformities and possible related complications. A search of the published literature was conducted following the PRISMA guidelines, including PubMed, Cochrane Library, and Ovid databases. Text words and Medical Search Headings (MeSH terms) were used to identify nine articles included in our analysis. The most used filler was Restylane (Galderma). The injection technique was performed through the use of a cannula or, more frequently, with a needle, through the execution of boluses or retrograde release. The injection plane was predominantly the supra-periosteal layer. The most observed side effects were mild and included redness, edema, contour irregularities, bruising, and blue-gray dyschromia. The degree of patient satisfaction was high, with an optimal aesthetic result that was maintained for 6 to 12 months. Although the duration of treatment of tear trough deformities with HA fillers is not comparable to surgical treatment, this is a minimally invasive, safe procedure, quick to perform, and with a high degree of patient satisfaction.

Highlights

The tear trough, known as the nasojugal sulcus, is the natural depression that extends inferolaterally from the medial canthus, delimited above by the infraorbital fatty bump, bounded superiorly by the infraorbital fat protuberance, whose inferior border is formed by the thick skin of the upper cheek [1,2,3]
According to the criteria described by Lambros, patients with smooth, thick skin with well-defined lacrimal sulcus can be successfully treated with hyaluronic acid (HA) injections [5]
The extraction of data from the nine evaluated articles allowed us to list a total of 830 patients treated for tear trough deformity with HA injection

Summary

Introduction

The tear trough, known as the nasojugal sulcus, is the natural depression that extends inferolaterally from the medial canthus, delimited above by the infraorbital fatty bump, bounded superiorly by the infraorbital fat protuberance, whose inferior border is formed by the thick skin of the upper cheek [1,2,3]. There are varying degrees of volume loss of the lacrimal sulcus; according to Hirmand, it is clinically possible to distinguish three classes: class I: the loss of volume is limited only medially to the lacrimal canal with or without slight flattening of the central cheek; class II: loss of both medial and lateral periorbital volume may be associated with moderate volume deficiency in the medial cheek and flattening of the upper central cheek; class III: characterized by marked circumferential depression along the orbital rim, often associated with marked depression of the cheek and malar eminence [4]. According to the criteria described by Lambros, patients with smooth, thick skin with well-defined lacrimal sulcus can be successfully treated with HA injections [5]. Two main classes of fillers can be distinguished: non-absorbable and resorbable ones such as HA, which can be dissolved through the use of Hyaluronidase (HYAL) [7,8]

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