Why the tear trough is my favorite treatment to perform
I would love to know who names these treatments. I mean seriously… tear trough? Tears are what you cry when you are sad. Troughs are an item pigs eat out of! The term tear trough filler is just wrong. That aside, the proper anatomical name for the tear trough is the nasojugal groove. Much better! Medical. Not scary or disgusting. But here we are.. So why do I love tear trough treatment?
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Dark circles and the tear trough
Why are the dark circles constituting the tear trough my favorite part of the face to treat? It’s simple really. The tear trough treatment with hyaluronic acid embodies everything I believe about how cosmetic treatments should be done and exemplifies several lessons that every doctor should know about performing any cosmetic procedure, and in particular facial cosmetic procedures.
4 rules for tear trough filler treatment with hyaluronic acid
- Less is more
- A little too much is way too much
- Filler does not wear away after 6 months
- Perfect is awful
Tear trough filler – Less is more?
So we all know by now less is more. Just like with all dermal filler, tear trough fillers need to be treated with caution. Volume loss in the lower eyelid, causes the dark circles that sit at the upper cheek. These tear trough hollows should be addressed very carefully to ensure natural looking results. What is noticeable immediately may not be what patients find after a few days. Just like breast surgeons overzealously treated patients in the 90s, tear trough fillers are being overzealously used by some doctors performing filler injections in this thin skin area.
Non surgical treatments are still catching up
Unfortunately, the world of tear trough fillers and Dermal fillers are still playing catchup with the lessons learned by surgeons learned many years ago. And nowhere is this more true than in the Tear trough. This tiny fat pad only takes an even tinier amount of filler to correct when we have lost fat in this area. But we have to be very careful
What exactly is the tear trough area anyway? How does it form?
The tear trough is a deformity you often see under your eye. With aging, and often even in young people and kids that haven’t yet aged, having less fat or a different bone structure in this under eye area can give others the impression that you are tired or perhaps even sick.
The tiny fat pad contains less than a teaspoon of fat on each side, and as you slowly lose fat with the aging process, you slowly look more tired under your eyes. Bouts of illness, lack of sleep or stress can contribute to the sunken appearance in this area. Everyone has seen this in themselves when they are unwell, dehydrated, sick, but when it remains as you age, we call it a tear trough deformity. (I prefer nasojugal groove!)
The under eye filler is simultaneously the easiest and also hardest part of the face to correct.
So, under-eye fillers replace the tiny bit of fat missing in this part of the face; so, what’s the big deal? Put it back! Well, because the area is so small and because there are a lot of blood vessels, very thin skin and soft tissue drainage issues in this area, precision is paramount.. This is why the tear trough separates the men from the boys ( and the women from the girls!)
A little too much dermal filler injections in the dark shadows can be disastrous.
Due to the poor fluid drainage under the eye and how many important vascular structures sit in this area, the tear trough filler procedure is not as forgiving as other dermal filler treatment areas parts of the face.
If you’ve ever been up at night crying as a kid, or been allergic to something you’ll have noticed this part of the face JUST LOVES to swell up. The lymph drainage system here means that if you overshoot the amount of filler you need in this area by just 1% it can result in swelling of 20-30%. Yes, just a tiny bit too much filler here can result in a lot more fluid retained in this area and therefore worse puffiness and worse bags!
More is not more in the tear troughs
Unfortunately many clinicians are unethical and or uneducated and they do not advise patients that filler, despite what the manufacturers suggest often lasts a lot longer than advertised. Why would an unethical doctor do that – it would affect the bottom line if they were to treat people with filler injection less often.
Well nowhere is it more true that filler accumulates and stays in the face than in the tear troughs! So if you didn’t go over by 1% the first time you did your tear trough filler, good on you and good on your doctor! However should you go with the often given bad advice to repeat treatments every year or, god forbid, every 6 months in this area, the chances of you overshooting and ending up with puffiness and bigger bags than you started with becomes astronomically higher.
Do you really need your tear troughs treated?
Before I explain that all is not lost and the reason this is my favourite area to treat in the right face, there is one more reason people have bad results in the tear trough.
Let me take the case of Kim kardashian, one of the first women to famously get tear trough treatment. Have a look at a picture of her in her paris hilton assistant days vs now. What do we notice…
She had tear troughs, and now she no longer has them. She looks airbrushed in real life! No tiredness…no eyebags… but look again closely.
Which picture looks better?
Tear trough fillers should be done carefully.
Did you know that monkeys, unlike humans have no nasolabial folds. This is the line from your nose to the side of your mouth. Everyone begins to form them pretty much from when we start smiling. And they get deeper as we age. They can be corrected with filler but should never be completely removed.
Just like the nasolabial fold, the tear troughs are an area that can show aging, poor health, or even, they say poor genetics! But is zero optimal? Do we look our best without a tear trough area at all? The answer is NO.
