The tear trough, also known as the nasojugal groove, is the inner portion of the lower eyelid. As we age, the fatty tissue under the lower eyelid and upper cheek area decreases naturally. The skin and muscles of the lower lid lose elasticity over time, causing the tear trough depression to become puffy or bulge away from the face. This can lead to the development of “bags” under the eyes and a shadowy appearance, commonly referred to as “dark circles.” Despite efforts to conceal them with makeup, the face can still appear tired and unhealthy. Tear trough rejuvenation or correction with dermal fillers is a popular procedure for both men and women looking to achieve a more rested, youthful, and refreshed appearance.
Expected Results after Tear Trough Injections
- Decreased hollowness underneath the eyes
- Diminished appearance of under-eye “dark circles”
- Reduced appearance of under-eye swelling or “bags”
- Overall more awake, refreshed, and rested appearance
Ideal Candidates for Tear Trough Injections
Good Candidates for Tear Trough Injections
- Mild to moderate hollowness underneath the eyes. Patients with more severe hollowness may be candidates for lower blepharoplasty (eyelid surgery).
- Desire to decrease the appearance of under-eye dark circles.
- Consistently being told by friends and family that their eyes appear “tired” or asked if they “got enough sleep.”
- Not on any medications that affect bleeding.
When is surgery a better option for tear trough correction?
Sometimes, patients may benefit more from undergoing a surgical procedure. This is especially true if their lower eyelids or lower eyelid muscles have too much laxity or looseness, or if they have larger lower eyelid bags or festoons (pouches of tissue in the cheek area right below the lower eyelid).
Tear Trough Injection Technique
The depressions between the lower eyelid and upper cheek are known as tear troughs. They extend outwards and downwards towards the cheek. Aging causes tear troughs to become deeper, longer, and more shadowed. Precisely placing tiny and well-dispersed amounts of hyaluronic acid filler in the tear trough region helps smoothen the appearance of the under eyes and refresh the overall appearance of the face.
“Medical providers that perform tear trough injections must be extremely comfortable with the orbital anatomy and demonstrate extreme caution. Careless injection techniques can result in poor aesthetic outcomes and, in unfortunate cases, severe medical consequences.” – Dr. Shervin Naderi, Founder of The Naderi Center for Plastic Surgery and Dermatology
Types of Tear Trough Corrections
Dark Circle Improvement
Tear trough injections by our Board Certified Dermatologist, Dr. Snodgrass. She injected 1 syringe of Juvederm Volbella to her under eyes. This significantly improved her dark circles and helped fill in her hollowness. NO MAKEUP.
Improved Appearance of Depressions under the Eyes
Now this beautiful young female appears more rested and youthful after 1 cc of Restylane was injected into tear troughs and midface.
Diminished Under Eye “Bags”
This patient had mid-face injections performed with Voluma combined with tear trough injections to diminish the appearance of under-eye “bags” and create a smoother contour between her under-eye and cheeks.
Best Types of Dermal Fillers Used for Tear Trough Correction
The type of hyaluronic acid (HA) dermal filler selected for tear trough injection depends on factors such as skin type, anatomical concern, skin texture, and thickness. The most commonly preferred dermal fillers at The Naderi Center include Restylane-L and Juvederm Volbella.
Restylane-L is an FDA-approved hyaluronic acid filler that uses patented NASH technology to produce a smooth gel through the cross-linking of hyaluronic acid molecules. Restylane-L has a more fluid and spreadable consistency, making it ideal for the tear trough region.
Juvederm Volbella is made using Juvederm’s proprietary Vycross™ technology, giving it an ultra-creamy texture that injects smoothly and delivers natural results. Juvederm Volbella absorbs less surrounding tissue volume than traditional fillers, allowing for better tear trough results with a lower chance of under-eye swelling.
Sharp Needle vs. Cannula Technique for Tear Trough Injection
A cannula is a hollow bore needle with a rounded blunt end that penetrates the skin. Many medical providers prefer to use cannulas for their injections due to a decreased risk of the blunt needle entering a small blood vessel during the injection. Using cannulas reduces the chances of bruising, bleeding, and vascular occlusion. Cannulas also allow for filler deposition without as many needle “pokes” in the skin.
The benefits of the cannula method for filler injection include:
- Decreased risk of bruising and bleeding
- Less pain with injections due to decreased needle sticks
- Reduced incidence of vascular occlusion causing tissue death
- Reduced downtime and recovery due to less bruising and swelling
While the safety profile of the cannula technique seems apparent, the traditional sharp needle method allows for better placement of smaller amounts of dermal filler. Highly skilled injectors often prefer the sharp needle method for advanced micro-droplet technique. The sharp needle technique with micro-droplet delivery of filler offers the most precise and accurate placement of dermal filler, and it is the preferred method at The Naderi Center.
Recovery after Tear Trough Correction
After filler injection, it is normal to experience some swelling, pinpoint bleeding, and bruising. If numbing cream was applied during the procedure, numbness may persist for another 1-2 hours. It is important to follow post-procedure instructions to minimize swelling, bruising, and downtime.
- Apply ice or a small bag of frozen peas to the treated area for 20 minutes on and 20 minutes off for the first 48 hours.
- Avoid strenuous exercise for 48 hours to reduce swelling and bruising.
- Do not manipulate, massage, rub, or poke the area unless specifically advised by your physician.
- Use makeup and concealer to cover up any bruising.
- Take Arnica supplements to help reduce the appearance of bruises.
- Eat pineapples and drink pineapple juice to minimize swelling.
- Do not over-evaluate your face for the first two weeks, as it is normal to have bruising, swelling, and asymmetry during this time.
- Take Tylenol for pain, as it is normal to experience some sensitivity in the injection area. Avoid NSAIDs such as Motrin and ibuprofen, as they can worsen swelling and bruising.
How long will my tear trough injections last?
Hyaluronic acid filler molecules can last up to 18 months in certain areas of the face. However, the visible effects of the fillers may last a shorter period. HA fillers last a shorter time in more dynamic and mobile areas such as the lips, but they last longer in less mobile areas such as the lower eyelid, tear troughs, or the nose.
“Full correction” is an essential concept in the longevity of filler results. Full correction refers to fully correcting the problem with the necessary amount of filler. If a patient opts for less filler than recommended for full correction, the results will be shorter-lived, and more frequent injections will be needed.
“The proper amount of volume injected as frequently as necessary is the best approach, but even a little volume injected less frequently can still help improve wrinkles and lines in many occasions.” – Dr. Shervin Naderi, Founder of The Naderi Center for Plastic Surgery and Dermatology
Risks, Safety, and Potential Complications of Tear Trough Injections
Common and expected side effects of tear trough injections include bruising, swelling, asymmetry, and the feeling of lumps and bumps. These side effects usually improve within 2 weeks as swelling resolves. However, tear trough injections come with potential complications, such as hypersensitivity or allergic reactions, cold sore or herpes simplex virus outbreak, acne breakout, skin necrosis, intra-vascular injection leading to skin necrosis and even blindness, and sterile abscess. Patients should notify their provider immediately if they experience any of these complications after filler injections.
Dr. Shervin Naderi has been recognized as one of the “Top 25 Injectors” by the 10 million member community of RealSelf. He is a board-certified facial plastic surgeon and a national clinical trainer for Allergan and Medicis. Dr. Naderi teaches other doctors how to inject fillers properly and is respected worldwide for his injection skills. Dr. Kulak, a facial plastic surgeon, and Dr. Alexandra Snodgrass, a board-certified dermatologist, are also tear trough injection specialists at The Naderi Center.
To schedule a consultation for tear trough correction with one of the specialists at The Naderi Center, contact us at 301-222-2020 (Chevy Chase, Maryland) or 703-481-0002 (Reston, Virginia). Virtual consultations are also available for out-of-town patients.