Non-Invasive Treatment for Tear Trough, Black Circles and Eyelid Bags

The purpose of dermal fillers is to restore or correct specific areas of the face when volume loss becomes apparent. In the face, they can be injected virtually everywhere by an expert physician. Each area of the face has its anatomy. The injections should follow specific rules that comply with the anatomy and physiology of the particular region that needs to be treated. Also, the injector has to establish a goal of the specific treatment and, on this basis, discuss the modality, the different materials that can be used, the quantity, the costs, eventual risks, and possible complications.

Non-surgical ‘eye-job’ with natural fillers offer long-lasting results and a significant improvement of your eyes, erasing signs of fatigue and aging:

From my published article.

Recent articles have shown that 80% of the patients seeking an aesthetic improvement of their face with a non-surgical treatment expressed a significant interest in rejuvenating the appearance of their eyes.

Sobanko JF, Percec I. Motivations for Seeking Minimally Invasive Cosmetic Procedures in an Academic Outpatient Setting. Aesthetic Surgery Journal 2015

The same study proved that most patients noticed to have shown the first signs of aging were the eyes. That’s why the role of a physician must be dedicated to the aesthetic of the eyes only, the oculoplastic surgeon!

The area of the face that I most often inject is the lower eyelids to correct the ‘tear trough’ deformity, dark circles, and lower lid bags. Also, the eyebrows can be injected laterally, giving a full appearance and a lifting effect to the brow’s tail. The cheek with the malar eminence is the second most injected site in my practice, alone or in conjunction with the lower eyelid. Restoring the proper volume in the cheeks/malar region will restore the natural V-shape of a youthful face, corrects the lower eyelid/cheek transition reforming the high cheekbone.

All this is achieved with a simple injection, invisible signs with an effect lasting as long as more than 1 year, depending on the product and amount of filler injected. Finally, the nasolabial folds, the jaw area, and the chin area can all be effectively injected at the same time.

Dermal Filler Materials

Nowadays, all the marketed products are re-absorbable and, therefore, temporary fillers. They can be made with hyaluronic acid or calcium hydroxyapatite; there are many brands, but I use only FDA-approved ones and have the most extended reports of patient safety and satisfaction. Botulinum toxin and fillers can be used together to treat different areas of the face with excellent compatibility. Can botulin toxin and fillers substitute surgery? Botulin toxin and fillers are a complement to surgery. Patients not ready for surgery can use these treatments as an initial procedure to attain rejuvenation.

Treatment: all treatments are performed in the office with minimal downtime and are painless. Occasionally, a small ecchymosis of the treated area may require ice packs and minimal makeup for the first 48 hours. Volume replacement techniques are becoming increasingly popular for the correction of periocular volume defects. Volume defects in the periocular region are typically localized between the inferior eyelid and the cheek but can also occur in the superior sulcus.

The naso-jugal groove medially, also known as ‘tear trough’ deformity, can extend laterally to the arcus marginalis, forming the so-called ‘hollow’. Infraorbital hollows can have a constitutional basis and, as such, be present since adolescence or can occur with aging, affecting young adults and middle-aged patients. The presence of infraorbital hollows is often associated with lower lid ‘bags’ and/or ‘dark circles,’ and the various combination of these defects gives a sad, tired look to the entire face. As oculoplastic surgeons, we are the first doctors consulted by these patients, and we should possess as many tools as possible to address these problems.

Injecting commercial fillers is the most common non-surgical modality for managing volume deficits in the periocular region. Filling the tear trough requires an experienced and skillful injector very familiar with the periocular area. Therefore this treatment is, in my opinion, to be administered by an Oculofacial Plastic Surgeon.

Each patient should be treated with an individualized choice of material, including hyaluronic acid, Radiesse, or lipofilling (fat grafting harvested from the patient himself) based on the patient’s desires, expectations, fears, and clinical indications.

Possibly due to the white color of the material, which allows improving the dark circles simultaneously, my personal preference is Radiesse in young patients and fat grafting for middle-aged patients that require some associated surgical procedure.


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