Tear Trough Deformity Research Articles

Application of infraorbital rim augmentation with pocket fat filling to correct tear trough deformity.

Tear trough deformity is one of the most common complaints in clinical settings. The correction of this groove is challenging in facial rejuvenation. The lower eyelid blepharoplasty varies with different conditions. A novel approach of using orbital fat in the lower eyelid to increase the volume of the infraorbital rim with granule fat injection has been applied in our institution for more than 5 years. This article aims to describe the detailed steps of our technique and verify its effectiveness by a cadaveric head dissection after surgical simulation. In this study, a total of 172 patients with tear trough deformity underwent lower eyelid orbital rim augmentation with fat filling in the sub-periosteum pocket. According to Barton's grades, 152 patients underwent lower eyelid orbital rim augmentation with orbital fat filling, 12 patients had it combined with autologous granule fat from other body parts, and 8 patients received only transconjunctival fat removal to correct tear trough. The modified Goldberg score system was used to compare preoperative and postoperative photographs. Patients were satisfied with the cosmetic results. Excessive protruding fat was released, and the tear trough groove was flattened by using autologous orbital fat transplantation. The lower eyelid sulcus deformities were well-corrected. To further illustrate the anatomical structure of the lower eyelid area and injection layers, six cadaveric heads were used for surgical simulation and demonstrated the effectiveness of our technique. This study indicated that the infraorbital rim could be increased by transplanting orbital fat to the pocket, which was dissected under the periosteum, and the procedure has been verified as reliable and effective. Level II.

Transconjunctival Fat Repositioning Blepharoplasty: Is Excess Fat Herniation a Prerequisite?

The fat repositioning technique has been widely used for the treatment of tear trough deformity, and there is a strong belief that excess fat herniation is a prerequisite for the procedure. The purpose of this study was to evaluate its effect in patients with minimal or no excess fat herniation. A total of 232 patients underwent the procedure and met the inclusion criteria. Of them, 198 were primary cases, and 34 had a hisory of fat removal for blepharoplasty. The amount of infraorbital fat was evaluated preoperatively by palpation. Release of the tear trough ligament and fat redistribution were sequentially performed as described previously. Surgical outcome was assessed based on the Hirmand grading system and the FACE-Q scales. Tear trough deformities were eliminated in more than 85% of cases. Aesthetic results were comparable between the primary and secondary surgery groups. The percentage of patients who complained of extremely or moderately severe tear trough deformities decreased from 86.3% preoperatively to 34.0% postoperatively. The scores of the lower eyelid FACE-Q decreased significantly ( P < 0.05). Patients were satisfied with their decision to undergo blepharoplasty (78.2 ± 18.7). Undercorrection of the tear trough occurred in 30 patients. Other complications included 12 cases of transient conjunctiva bleeding, two cases of eyelid numbness, and six cases of dry eye. These resolved spontaneously. Fat repositioning is a feasible and effective technique for the treatment of tear trough deformities in patients with minimal or no excess orbital fat herniation, provided that a fat pad is palpable. Therapeutic, IV.

Internal Fixation of Redistributed Orbital Fat in Transconjunctival Lower Eyelid Blepharoplasty.

Fat redistribution combined with release of the tear trough ligament in transconjunctival lower blepharoplasty is widely performed to correct lower eyelid bags and tear trough deformities, but suturing the released fat in such a narrow, dissected space remains a challenge. The purpose of this study was to introduce a new surgical technique of internal fixation that advances and sutures the pedicled orbital fat firmly to the midcheek through premaxillary and prezygomatic spaces. Twenty-two patients (age range, 22 to 39 years) with predominant orbital fat prolapse and tear trough deformity without noticeable lower eyelid skin laxity were treated with this method, all of whom had impressive correction of the eyelid bags and tear trough deformities and were pleased with the aesthetic results during an average follow-up of 11.8 months (range, 10 to 14 months). No patient had postoperative hematoma, ectropion, or midface numbness. The maneuver of internal fixation of redistributed orbital fat provides a novel and safe approach to correct eyelid bags and tear trough deformities without additional percutaneous sutures in transconjunctival lower eyelid blepharoplasty. Therapeutic, IV.

Novel treatment protocol for combined tear through ligament stretching and injection.

Complex anatomical changes have been the main challenges for optimal treatment results of tear trough deformities through hyaluronic acid (HA) injections. This study presents a novel technique consisting of a pre-injection tear trough ligament stretching (TTLS-I) leading to its release, and compared its efficacy, safety and patient satisfaction to tear trough deformity injection (TTDI). This was 4-year retrospective single-center cohort study of 83 TTLS-I patients, with a follow-up period of one year. One hundred and thirty five TTDI patients served as a comparison group.Outcome analyses included the analysis of possible risk factors for adverse outcome, as well as comparative statistics between the complication and satisfaction rates among the two groups. TTLS-I patients received significantly less hyaluronic acid (HA) (0.3cc (0.2cc-0.3cc)) than TTDI patients (0.6cc (0.6cc-0.8cc), p<0.001). The injected HA amount was a significant predictive factor for complications (p<0.05).Complication rates assessed during the follow-up visit for hematomas, edema, as well as the need for corrective hyaluronidase injection were low in both groups, with no significant differences among both groups. TTDI patients had significantly higher rates (5.1%) of lump surface irregularities during follow-up compared to 0% in the TTLS-I group (p<0.05).After one year of follow-up, 98.8% of TTLS-I patients were satisfied whereas TTDI patients were satisfied in 95.6%, with no significant difference. TTLS-I is a novel, safe and effective treatment method, necessitating significantly less HA compared to TTDI. Moreover, it leads to very high satisfaction, as well as very low complication rates.

Surgical Correction of Tear Trough Deformity (TTD) with Orbicularis Retaining Ligament Release and Volume Augmentation for Periorbital Rejuvenation: Review of the Literature.

Tear trough deformity is a hallmark of periorbital aging. It is not, however, an exclusive feature of old age. While protruding orbital fat results in lower lid bags that are traditionally corrected by excision, correction of TTD can constitute a real challenge requiring volume enhancement in addition to addressing prolapse of orbital fat and descent of cheek tissues. Described therapeutic options include minimally invasive soft tissue augmentation with fillers or structural autologous fat transfer as well as invasive surgical procedures concomitantly with lower lid blepharoplasty or other facial rejuvenation procedures. Six eponyms have been used in the literature to describe the condition: (1) naso-jugal fold, (2) naso-jugal groove, (3) naso-jugal ditch, (4) tear trough, (5) tear trough deformity, and (6) tear trough depression. A separate PubMed database search of each of the 6 terms was conducted in addition to an advanced literature and systematic PICO searches to identify all described clinical retrospective or prospective, comparative or simple cohort studies related to surgical correction of TTD. An additional screening of references of retrieved clinical studies was performed to identify any missed reports. A total of 435 publications were identified with the initial search. After excluding all none relevant studies, 44 papers were selected for review. 6 additional studies were identified by screening relevant references. Almost all authors agree on the necessity to release the tear trough retaining ligament together with volume enhancement. Transconjunctival and transcutaneous incisions are reported. Most recommend repositioning of the protruding orbital fat for volume enhancement to mostly subperiosteal, or pre-periosteal pockets. Other reported options include pedicled buccal fat pad transposition, segmental fat grafting, and minced micrografts. Internal as well as external fixation of repositioned fat flaps have been described. Despite lack of solid objective evidence, several of these techniques when properly executed for the proper indication in selected patients are reported to result in a rewarding and long-lasting outcome. Unfortunately, it is difficult to determine the most appropriate technique that would universally yield the most pleasant and harmonious facial contour without creating an unnatural puffy appearance. It remains for the surgeon to identify the safe surgical approach that does not compromise lower eyelid function and achieves the most pleasing aesthetic outcome with the least complications and downtime. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Tear trough ligament reset as a new method for tear trough deformity and dark circles correction

Tear trough deformities and dark circles are important parts of periorbital aging. In this study, the tear trough ligament was reset to correct the tear trough deformity, and its effect on dark circles was analysed. The medical records of 60 patients who underwent eye bag plastic surgery between January 2021 and February 2022 were analysed (30 had traditional eye bag plastic surgery and 30 had the tear trough ligament reset). The tear trough deformity score and the dark circle score showed that the corrective effect on the tear trough deformity in the reset group was better than in the traditional surgery group at six-month follow up (mean (SD) tear trough rating scale (TTRS) score = 4.82 (0.95) vs 5.92 (1.00), p < 0.0001; L* value 55.27 (2.90) vs 47.51 (3.00), p < 0.0001). The satisfaction of patients in the reset group was significantly higher than it was in the traditional surgery group (25/30 vs 18/30, p = 0.045). Tear trough ligament reset is a safe and effective surgical method of periorbital rejuvenation, especially for beauty seekers with obvious tear trough deformities.

Extending the Indications for Direct Transcutaneous Lower Blepharoplasty With an Infraorbital Incision to Tear Trough Deformities, Suborbicularis Oculi Fat, Festoons, and Revision Blepharoplasty.

Introduction: Treatment of high-grade lower eyelid deformities with massive skin laxity and retroseptal fat pads can be challenging. Common techniques such as the transconjunctival approach and transcutaneous technique performed through a subciliary incision are associated with increased complication rates. Direct excision of the lower eyelid through an infraorbital incision is an alternative technique that allows safe treatment of dermatochalasis and pigmentation and correction of tear trough deformities, suborbicularis oculi fat, and festoons. This study aimed to determine whether direct transcutaneous blepharoplasty with an infraorbital incision could be indicated for these conditions instead of the established operative methods. Methods: A retrospective study of 21 patients with Fratila grades 9 or 10, Hirmand grade 3, and Barton grade 3 who underwent direct transcutaneous lower eyelid blepharoplasty via an infraorbital incision under local anesthesia was performed. All patients underwent surgery during a 9-year period from January 2010 to December 2018. The follow-up period was 12 months. Results were rated postoperatively using Barton grading. Results: Of 21 consecutive patients (13 women and 8 men), 18 required retroseptal fat pad removal, 3 had laxity of the skin and orbicularis muscle, and 5 had triangular cheek festoons. Combined lower and upper blepharoplasty was performed for 12 patients. All patients were satisfied with their surgical results and major improvements were observed. Scar quality was considered good by all patients. Conclusion: Direct transcutaneous lower blepharoplasty of the orbital rim can be indicated for different tear trough deformities, suborbicularis oculi fat laxity, and festoons.

Comprehensive Treatment of Lower Eyelid Plasty Based on Intraoral Fixation and Redistribution of Lower Eyelid Fat.

Eye bags especially give an impression of aging and mental exhaustion. At present, the surgical methods of bags mainly include conjunctival approach and lower eyelid skin approach. With the continuous upgrading of the concept of facial esthetics, the lower eyelid pouch surgery for middle-aged and elderly patients pays more attention to reducing surgical trauma, improving tear trough deformity along with the effacement of lid‑cheek junction. This paper discusses the clinical effect of the lower lid blepharoplasty involved orbital septum fat repositioning based on oral fixation via conjunctival approach combined with relaxation skin resection in the treatment of eye bags in elderly patient. Fifty elderly patients underwent blepharoplasty between January of 2021 and June of 2021 at our hospital. The lower eyelid orbital septum fat was released along with the prezygomatic space and the premaxillary space were stripped through the conjunctival approach. The released cellulite was redistributed in the prezygomatic space/premaxillary space and fixed in the oral vestibular with 5-0 Polysorb through the middle facial tunnel. Finally, the appropriate skin was finally removed. After operation, 48 patients were satisfied with the operation results, with tight lower eyelid skin and natural lid‑cheek junction. One patient with conjunctival infection was cured after 7 days of antibiotic eye drops. One patient felt foreign body when chewing, and the symptoms disappeared naturally after 5 days without treatment. For middle-aged and elderly patients with bags, the surgical method in this study not only has good postoperative effect, but also has small damage to the lower eyelid orbicularis muscle. The appearance is natural and the lower eyelid skin is tight. The effacement of lid‑cheek junction and recreating a smooth transition of lower lid cheek interface, which can correct lacrimal groove deformity. The patients have high acceptance and satisfaction, which can be widely used in clinical practice.

Retrospective study of the absorbable braided polydioxanone threads' usefulness in the aged lower eyelids' rejuvenation.

Tear trough deformity, hyperpigmentation, and skin laxity of the lower eyelid make individuals appear fatigued and elderly. Many patients prefer less invasive, cosmetic correction of the aged lower eyelid. Polydioxanone (PDO)-barbed threads introduced braided fine threads design, which works as a template for attraction of the regenerative factors and for cells' migration and proliferation. The purpose of this study was to estimate the outcomes of simultaneous additional application of braided type PDO threads (N-scaffold) for aged lower eyelids' rejuvenation in patients, who underwent the midface PDO thread lifting. A total of 30 patients with mildly loose skin in the facial area, who underwent the thread lifting using PDO threads, were included in this study. Patients were divided into two groups, 15 patients per group. The first group underwent the midface thread lifting using PDO threads ("non-SCA" group). The second group underwent midface thread lifting in combination with braided PDO threads for tear trough deformity improvement ("N-scaffold" group). The results were evaluated subjectively, based on the patients' satisfaction rates, and objectively, by evaluating photographs. According to Barton's grading system, 7 months after the treatment, there was a statistically significant difference between the two groups: 1.733 ± 0.74 in the non-SCA group and 0.733 ± 0.83 in the N-scaffold group (p < 0.05). Based on patients' self-assessment, there was a significant difference at 7months after the treatment: 2.86 ± 0.84 in "non-SCA" group and 3.76 ± 0.90 in "N-scaffold" group, p < 0.05. Complications such as persistent swelling, hematoma, skin irregularity, and infection were not observed during follow-up assessments. The application of braided type PDO threads (N-scaffold) as part of the midface thread lifting, for aged lower eyelids rejuvenation appears to be effective and safe within a period. This study suggests that PDO threads insertion may be a useful, additional, and non-invasive tool for the aged lower eyelids rejuvenation.

Tear Trough Ligament Release and Autologous Fat Injection as a New Method for Tear Trough Deformity Correction.

Even though the tear trough (TT) deformity is only 2cm in length, it can give a worn, even haggard appearance on the face. The authors developed a novel approach and presented findings from the clinical effect. Between February 2018 and January 2021, the medical records of patients treated with autologous fat injection for TT deformity were researched. The fat was placed under the orbicularis oculi muscle with a sharp cannula. During that period, the TT ligament was also released with the cannula. After the fat was injected entirely, we still needed to repeatedly puncture this ligament to release it until there was no puncture resistance. Improvement was evaluated by measuring patients' and investigators' global aesthetic improvement scale. 152 of 173 patients completed the follow-up plan and were enrolled in this study. The most common complications reported were temporary swelling and lumpiness. At 1 month, 3 months, 6 months, 12 months, and 24 months, the satisfaction rate of patient self-assessment was 93.4%, 89.5%, 86.8%, 84.3%, and 82.4%, respectively. The Investigator Global Aesthetic Improvement Scale showed 94.1% of patients' improvement after one month, 83.6% after three months, 78.3% after six months, 75% after 12 months, and 71.8% after 24 months. Fat injection based on TT ligament release to correct TT deformity is a novel, easy and effective treatment that deserves to be further used. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Thickness-adjustable Injectable Poly-D,L-Lactic Acid: A Versatile Filler.

In recent years, there has been increasing popularity and interest in injectable fillers for facial rejuvenation. Hyaluronic acid (HA) fillers are the most widely used injectable fillers. Although there are many kinds of HA fillers on the market, each HA filler has its own rheological properties. Various facial regions may need fillers with different rheological properties. Therefore, there is no one HA filler suitable for all indications.1 Injectable poly-D,L-lactic acid (PDLLA; AestheFill, REGEN Biotech, Seoul, South Korea) is a collagen-stimulating filler.2,3 Recently, we published two articles in the Plastic and Reconstructive Surgery—Global Open journal.4,5 A vial of injectable PDLLA can be reconstituted by 1.5–24 mL of sterile water.4,5 The suspensions are further divided into four groups of density for different indications of injection: thickest (D1.5–D3), thick (D3–D6), thin (D6–D12), and super-thin (D12–D24).4 Various suspensions have different rheological properties. However, they have never been discussed in previous articles. The purpose of this article is to discuss the properties and volume effect variations of four groups on their different indications. According to our experience and the animal studies,2 by using D1.5 suspension, volume decrease after injectable PDLLA administration is found to be minimal. Thereafter, the volume effect could last for 2 years. By using suspensions other than D1.5, volume decrease occurs several days after injection due to absorption of additional water. Then, the residual volume remains the same and lasts for 2 years. Therefore, additional water approximately equals the water that exceeds 1.5 mL per vial. (See table, Supplemental Digital Content 1, which illustrates the properties and indications of four groups of PDLLA, https://links.lww.com/PRSGO/C50.) For nasal and chin injection, “thickest” suspension is used because of its high elastic modulus (G’) and cohesivity. With high G’, the projection can be maintained because it can resist the compression force of overlying skin, fat, and muscle over bony prominences. With high cohesivity, lateral spreading of the filler is minimal.1 For wrinkle correction or volume augmentation, it is better to use a filler that can spread easily so as to prevent the occurrence of obvious edges and bumps from happening. A filler with medium-to-low cohesivity would be the best choice.1 Accordingly, “thick” suspension for deep wrinkle correction and “thin” suspension for shallow wrinkle correction are used. Additional water in these suspensions will be absorbed several days after injection. Therefore, overcorrection by using “thick” and “thin” suspensions seldom happens. For texture improvement over a large area skin, only the property of easy spreading is needed, instead of the volumizing effect of the filler. As a result, “super-thin” suspension would be the choice (Fig. 1).Fig. 1.: A 24-year-old woman who received “thickest” suspension of injectable poly-D,L-lactic acid injection for her chin and hump nose, “thick” suspension for her naso-labial folds, “thin” suspension for her tear-trough deformities, and “super-thin” suspension for her mid-facial skin texture. A, Preoperative view. B, Eight-month postoperative view. (Photographs courtesy of Chuan-Yuan Lin, MD.)There are some limitations in using this filler. The injection planes are the supra-periosteum and subcutaneous layers. Care must be taken not to inject the filler into other layers. For example, intramuscular injection easily causes nodule formation. Additionally, there is no dissolving enzyme for injectable PDLLA. Practitioners who intend to administer injectable PDLLA must be aware of potential risks and the management of adverse effects should they arise. Nevertheless, injectable PDLLA is a versatile filler for a wide range of indications. PATIENT CONSENT The patient provided written consent for the use of her image. DISCLOSURE Drs. Lin and Lin are medical consultants of Jiangsu Wuzhong Aesthetic Biotech., and medical directors of REGEN Biotech. ACKNOWLEDGMENT The authors want to give special thanks to Normand Mailhot-ME-TESL for his kind assistance with manuscript editing.

Nonsurgical lower eyelid rejuvenation using injectable poly-d,l-lactic acid in Asian patients.

Filler injection for lower eyelid rejuvenation remains a difficult subject due to many complicated anatomic changes as the face ages. To propose an alternative, simple, and effective filler injection method in lower eyelids for Asian patients. Any patient who has tear trough deformities, infra-orbital hollows, nasojugal grooves, dark eye circles, as well as mild eyebags is a potential candidate for this method. Our filler choice is injectable poly-d,l-lactic acid (PDLLA; AestheFill; REGEN). PDLLA must be reconstituted with sterile water for injection (SWFI) before administration. When the patient's troughs, grooves, or volume deficit are classes II and III, 3-4ml of SWFI and 1ml of lidocaine are used. When the deficits are class I, 5-7ml of SWFI and 1ml of lidocaine are used. With the fanning injection technique, a wide region that covers all the deficits is evenly injected. The depth is under the dermis layer. The total amount of filler injection is not more than 2ml on each side. Since 2019, we have injected more than 100 patients by following these steps in Taiwan. The level of patient satisfaction is high. Only some mild and transient post-injection complications such as edema, erythema, and ecchymosis were found. We propose an alternative, simple and effective method for non-surgical lower eyelid rejuvenation for Asian patients. However, anyone who wants to perform this procedure should be well-trained and knowledgeable about the anatomy, product, and procedure to prevent adverse events.

Expert Recommendations on the Use of Hyaluronic Acid Filler for Tear Trough Rejuvenation.

Restylane&reg; Lidocaine is one of the most widely used hyaluronic acid (HA) fillers to replace lost or displaced volume during tear trough correction. Patient goals for tear trough correction include looking less tired or removing dark circles and this may be achieved by administering HA filler into the infraorbital region to correct the lower eyelid relative to the volume deficit, thereby smoothing the transition from the lower eyelid to the cheek. To achieve patient satisfaction and consistent results with Restylane, optimal application is essential; however, clinical guidance based on experience is limited. This paper reflects the recommendations of an interdisciplinary expert panel for the use of Restylane in correcting tear trough deformity, including patient selection, dosing, injection technique, and post-treatment care. Recommendations were discussed and agreed as a consensus, according to cross-sectional expertise and clinical experience. J Drugs Dermatol. 2022;21(4):387-392. doi:10.36849/JDD.6597.

Anatomical Characterization of the Tear Trough and the Lid-Cheek Junction: An Iodine Staining Technique Based on High-Resolution Micro-Computed Tomography.

The literature presents the tear trough and lid-cheek junction's controversial anatomical explanations. In this study, the authors explored the anatomical characterization of the tear trough deformity and lid-cheek junction. Twelve human cadaver specimens were obtained from the authors' anatomy department. Iodine staining and high-resolution micro-computed tomography was used to observe the suborbital area's anatomy. Anatomical studies and histologic evaluation were performed. The orbicularis retaining ligament is composed of a main septum right on the rim and multiple fibrous septa in the retro-orbicularis plain. The septum arises from the deep fascia of the palpebral part of the orbicularis oculi at approximately the level of the medial corneoscleral limbus, anchors the muscle to the orbital rim, and continues laterally as the lateral orbital thickening at the lateral canthus. Along the lid-cheek junction, multiple fibrous septa emanating from the deep fascia of the orbital part of the orbicularis oculi converge to the above septum. Using three-dimensional simulation, the skin-insert junction between the pre-palpebral part of the orbicularis oculi and pre-orbicularis oculi fibers precisely corresponded with the tear trough and the lid-cheek groove. Anatomical studies and histologic evaluation confirmed these observations. The orbicularis retaining ligament's subtle anatomical features are clearly seen using the approach described. The tear trough and the lid-cheek junction's anatomical characterization is defined by a suborbital ligament-fascia system whose description has implications in designing lower eyelid cosmetic surgery.

Corrective treatment for tear trough deformity in a young population utilizing two-dimensional fat injections.

Tear trough deformity (TTD) is becoming a growing concern for those seeking facial rejuvenation, and various treatment strategies have been reported. Among treatment options is micro-autologous fat injection, which appears to be an effective approach to recontour the tear trough in the young. The study we present here investigated the reliability and effectiveness of two-dimensional fat injections (TDFI) in the treatment of young patients with TTD. This study evaluated patients with TTD who underwent TDFI between December 2018 and December 2020. The proposed procedure involved ligament releasing and fat injection into the tear trough in two different directions. The average age of the 102 enrolled patients was 25.9±3.8years. Significant improvement and maintenance of TTD were observed during the follow-up period (13.2months average) with no major complications being observed. Improvement of dark cycles and enhanced aegyo sal were observed. Patient satisfaction based upon self-administered post-procedure questionnaires disclosed that 58.8% were very satisfied, 38.2% were satisfied, and 2.9% neutral with the results. Two-dimensional fat injections is an effective and reliable method with high satisfaction and low risk of complication. Long-term results demonstrated its utility for young-type TTD.

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

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.

Innovative approach for tear trough deformity correction using higher G prime fillers for safe, efficacious, and long-lasting results: A prospective interventional study.

One of the most challenging areas for facial rejuvenation is the lower eyelid. Apart from the protruding orbital fat causing lower lid bags, a discrete entity called the "tear trough deformity" is distinguishable in this area. The objective of this study is to compare and evaluate the standard technique of tear trough deformity correction with the lateral injection technique using a high G prime filler to establish a guideline for the safe and effective correction of tear trough deformity. A prospective, double-blind, study was carried out from Dec 2017 to 2019 including 30 participants in the age range of 35-60years. The participants were divided into two groups of 15 patients each. In group A patients, conventional technique with a low G Prime filler was used, whereas in group B, lateral injection technique with a high G Prime filler was used. Marked improvement was seen in appearance and skin quality on both the sides in all the patients. As compared to our technique (lateral injections) where a mean of 0.5ml of filler was used to lift the cheek and reduce the tear trough, the standard technique (Mauricio de Maio's 3-point tear trough reshape technique) required a mean of 1.2ml of filler for the same. Post-procedure complications including bruising and Tyndall effect were much higher (statistically significant) using the standard medial technique for the correction tear trough. Aesthetically satisfying results for the tear trough correction are possible, without actually injecting the tear trough directly, based on the knowledge of the underlying anatomy.

Hyaluronic acid injections in post-enucleation or evisceration socket syndrome: a case series

BackgroundOne of the primary goals of enucleation and evisceration surgery is the restoration of an adequate orbital volume through the use of appropriately sized alloplastic or autogenous tissues. In patients inadequately treated, post-enucleation or evisceration socket syndrome occurs. Fillers are an ideal alternative for eyelid and eyebrow arcade volume enhancement since their injection is easily performed in an outpatient setting avoiding several complications. The aim of this study is to report the use of hyaluronic acid (HA) fillers to treat volume deficits of the upper and lower eyelids, projecting the brow arcade and reducing the asymmetry.MethodsThirteen patients (2 male, 11 female, mean age 32.7 years) were treated from June 2012 to May 2020. Non-surgical treatment by HA filler injection for aesthetic rehabilitation of deep superior sulcus, inferior tear trough deformity, and scleral show was performed.ResultsNo complications as orbital-ache and/or vasovagal response were reported during the injections. Minor complications such as light swelling at the site of injection, self-resolved within 2 days, were recorded. Stable results were observed at follow-ups. In two cases, two successive treatments were required at 3 and 6 years from the first injection.ConclusionsHyaluronic acid fillers offer a versatile and safe method for replacing soft tissue lost from the upper eyelid/brow complex in cases of post-enucleation or evisceration socket syndrome.Level of evidence: Level IV, therapeutic study.

Effects of Fat Repositioning for Tear Trough Deformity on Eye Movement.

Fat repositioning is a common surgical technique for treating tear trough deformity. As this technique is mainly performed for cosmetic purposes, its functional outcomes have rarely been evaluated. The purpose of this study was to evaluate the changes in eye movements that occur after fat repositioning for tear trough deformity. The authors performed fat repositioning on 18 eyelids of 9 patients and evaluated their eye movements and binocular vision before surgery and at 1, 3, and 6 months after surgery. Hess screen and Binocular single vision tests were performed during each follow-up examination and the scores were recorded. The authors observed that fat repositioning did not affect binocular vision; however, vertical and horizontal eye movements worsened at 3 months after surgery. Nevertheless, there was no significant difference between the eye movements recorded before surgery and those recorded 6 months after surgery. Regardless of this finding, it should be noted that vertical or horizontal strabismus might occur after fat repositioning for tear trough deformity.

Correction of tear trough deformity by hyaluronic acid soft tissue filler placement inferior to the lateral orbital thickening.

Tear trough deformities can be a sign of facial aging and exert a negative impact in facial attractiveness. Surgical techniques and adipose tissue transfer have been used to improve tear trough deformity. In recent years, minimal invasive procedures such as soft tissue filler injections became more popular. We report a retrospective evaluation of 45 Caucasian female patients ≥40 years (mean age of [58.8 ± 8.9] years). Severity of tear trough was classified according to Hirmand: 3 as grade I, 28 as grade II, and 14 grade III tear trough deformities. We used a monophasic hyaluronic acid, low G prime filler placed inferior to the lateral orbital thickening. On average, 0.4ml of hyaluronic acid (HA) filler were injected per side. The improvement was I grade 29 patients and II grades in 16 patients. The improvement lasted (10.8 ± 2.3) months. No severe adverse events were noted. Vascular danger zones can be avoided.