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Introducing the suborbital retaining ligament, subseptal, and retroseptal spaces: a novel technique for non-surgical correction of tear trough deformity

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European Journal of Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

Non-surgical correction of tear trough deformity using dermal fillers poses multiple challenges even in experienced hands. Herein, a retrospective study of patients treated using a novel technique for the correction of this deformity is presented.

Methods

The review of tear trough deformity anatomy and classification, patient assessment, and injection technique is performed. This technique introduces the suborbital retaining ligament, subseptal, and retroseptal spaces, along with a consistent and reproducible method for their precise identification using a micro cannula.

Results

From September 2019 until September 2021, a total of 310 patients and 620 tear troughs were treated with this technique. The average volume of filler used was 0.35 cc (0.2–0.5) per eye. Patients required a median (IQR) of 2 (1–3) treatment sessions. Overall patient satisfaction was high in the vast majority of patient, with no serious complications reported.

Conclusions

Adoption of this novel concepts may aid practitioners for precise placement of the fillers in specific anatomical spaces according to the type of deformity, providing optimal results while reducing complications.

Level of evidence: Level IV, therapeutic study

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References

  1. Hirmand H (2010) Anatomy and nonsurgical correction of the tear trough deformity. Plast Reconstr Surg 125(2):699–708

    Article  CAS  PubMed  Google Scholar 

  2. Lambros VS (2007) Hyaluronic acid injections for correction of the tear trough deformity. Plast Reconstr Surg 120(6 Suppl):74S–80S

    Article  PubMed  Google Scholar 

  3. Hussain SN, Mangal S, Goodman GJ (2019) The Tick technique: A method to simplify and quantify treatment of the tear trough region. J Cosmet Dermatol 18(6):1642–1647

    Article  PubMed  Google Scholar 

  4. Flowers RS (1993) Tear trough implants for correction of tear trough deformity. Clin Plast Surg 20(2):403–415

    Article  CAS  PubMed  Google Scholar 

  5. Bosniak S, Cantisano-Zilkha M, Purewal BK, Torres JJ, Rubin M, Remington K (2007) Defining the tear trough. Ophthalmic. Plast Reconstr Surg 23(3):254–255

    Article  Google Scholar 

  6. Yang C, Zhang P, Xing X (2013) Tear trough and palpebromalar groove in young versus elderly adults: a sectional anatomy study. Plast Reconstr Surg 132(4):796–808

    Article  CAS  PubMed  Google Scholar 

  7. Mendelson BC, Jacobson SR (2008) Surgical anatomy of the midcheek: facial layers, spaces, and the midcheek segments. Clin Plast Surg 35(3):395–404

    Article  PubMed  Google Scholar 

  8. Levesque AY, de la Torre JI (2015) Midface anatomy, aging, and aesthetic analysis. Facial Plast Surg Clin North Am 23(2):129–136

    Article  PubMed  Google Scholar 

  9. Alghoul M, Codner MA (2013) Retaining ligaments of the face: review of anatomy and clinical applications. Aesthet Surg J 33(6):769–782

    Article  PubMed  Google Scholar 

  10. Sykes J, Olds C (2021) Anatomic Trends and Directions in Periorbital Aesthetic Surgery. Facial Plast Surg Clin North Am 29(2):155–162

    Article  PubMed  Google Scholar 

  11. Trévidic P, Kaufman-Janette J, Weinkle S, Wu R, Dhillon B, Antunes S, Macé E, Maffert P (2022) Injection Guidelines for Treating Midface Volume Deficiency With Hyaluronic Acid Fillers: The ATP Approach (Anatomy, Techniques, Products). Aesthet Surg J 42(8):920–934

    Article  PubMed  PubMed Central  Google Scholar 

  12. Wong CH, Mendelson B (2013) Facial soft-tissue spaces and retaining ligaments of the midcheek: defining the premaxillary space. Plast Reconstr Surg 132(1):49–56

    Article  CAS  PubMed  Google Scholar 

  13. Barton FE Jr, Ha R, Awada M (2004) Fat extrusion and septal reset in patients with the tear trough triad: a critical appraisal. Plast Reconstr Surg 113(7):2115–2121

    Article  PubMed  Google Scholar 

  14. Turkmani MG (2017) New Classification System for Tear Trough Deformity. Dermatol Surg 43(6):836–840

    Article  CAS  PubMed  Google Scholar 

  15. Naik MN (2016) Hills and Valleys: Understanding the Under-Eye. J Cutan Aesthet Surg 9(2):61–64

    Article  PubMed  PubMed Central  Google Scholar 

  16. Naik M (2013) Blepharoplasty and periorbital surgical rejuvenation. Indian J Dermatol Venereol Leprol 79(1):41–51

    Article  PubMed  Google Scholar 

  17. Kato K, Kaijwara T, Furuyama N, Liew S (2023) Filler-based correction of tear trough depressions and eye bags in Japanese patients: A classification system and treatment algorithm. J Cosmet Dermatol 22:439–448

    Article  PubMed  Google Scholar 

  18. Hexsel D, Soirefmann M, Porto MD, Siega C, Schilling-Souza J, Brum C (2012 Feb) Double-blind, randomized, controlled clinical trial to compare safety and efficacy of a metallic cannula with that of a standard needle for soft tissue augmentation of the nasolabial folds. Dermatol Surg 38(2):207–214

    Article  CAS  PubMed  Google Scholar 

  19. Nanda S, Bansal S, Lakhani R (2021) Use of Hyaluronic acid fillers in treatment of periorbital melanosis induced by tear trough deformity: Anatomical considerations, patient satisfaction, and management of complications. J Cosmet Dermatol 20(10):3181–3189

    Article  PubMed  Google Scholar 

  20. Murthy R, Roos JCP, Goldberg RA (2019) Periocular hyaluronic acid fillers: applications, implications, complications. Curr Opin Ophthalmol 30(5):395–400

    Article  PubMed  Google Scholar 

  21. D’Amato S, Fragola R, Bove P, Lo Giudice G, Gennaro P, Vitagliano R, Staglianò S (2021) Is the Treatment of the Tear Trough Deformity with Hyaluronic Acid Injections a Safe Procedure? A Systematic Review. Applied Sciences 11(23):11489

    Article  Google Scholar 

  22. Chatrath V, Banerjee PS, Goodman GJ, Rahman E (2019) Soft-tissue Filler-associated Blindness: A Systematic Review of Case Reports and Case Series. Plast Reconstr Surg Glob Open 7(4):e2173

    Article  PubMed  PubMed Central  Google Scholar 

  23. King M (2016) Management of Tyndall Effect. J Clin Aesthet Dermatol 9(11):E6–E8

    PubMed  PubMed Central  Google Scholar 

  24. Berros P, Lax L, Bétis F (2013) Hyalurostructure treatment: superior clinical outcome through a new protocol-a 4-year comparative study of two methods for tear trough treatment. Plast Reconstr Surg 132(6):924e–931e

    Article  CAS  PubMed  Google Scholar 

  25. van Loghem JAJ, Humzah D, Kerscher M (2017) Cannula Versus Sharp Needle for Placement of Soft Tissue Fillers: An Observational Cadaver Study. Aesthet Surg J 38(1):73–88

    PubMed  Google Scholar 

  26. Pavicic T, Frank K, Erlbacher K, Neuner R, Targosinski S, Schenck T, Gotkin RH, Cotofana S (2017) Precision in Dermal Filling: A Comparison Between Needle and Cannula When Using Soft Tissue Fillers. J Drugs Dermatol 16(9):866–872

    PubMed  Google Scholar 

  27. Schelke L, Decates T, Kadouch J, Velthuis P (2020) Incidence of Vascular Obstruction After Filler Injections. Aesthet Surg J 40(8):NP457–NP460

    Article  PubMed  PubMed Central  Google Scholar 

  28. Shah-Desai S, Joganathan V (2021) Novel technique of non-surgical rejuvenation of infraorbital dark circles. J Cosmet Dermatol 20(4):1214–1220

    Article  PubMed  Google Scholar 

  29. Berros P (2010) Periorbital contour abnormalities: hollow eye ring management with hyalurostructure. Orbit 29(2):119–125

    Article  PubMed  Google Scholar 

  30. Mustak H, Fiaschetti D, Goldberg RA (2018) Filling the periorbital hollows with hyaluronic acid gel: Long-term review of outcomes and complications. J Cosmet Dermatol 17(4):611–616

    Article  PubMed  Google Scholar 

  31. Hall MB, Roy S, Buckingham ED (2018) Novel Use of a Volumizing Hyaluronic Acid Filler for Treatment of Infraorbital Hollows. JAMA Facial Plast Surg 20(5):367–372

    Article  PubMed  PubMed Central  Google Scholar 

  32. Diwan Z, Trikha S, Etemad-Shahidi S, Alli Z, Rennie C, Penny A (2020) A Prospective Study on Safety, Complications and Satisfaction Analysis for Tear Trough Rejuvenation Using Hyaluronic Acid Dermal Fillers. Plast Reconstr Surg Glob Open 8(4):e2753

    Article  PubMed  PubMed Central  Google Scholar 

  33. Tran C, Carraux P, Micheels P, Kaya G, Salomon D (2014) In vivo bio-integration of three hyaluronic acid fillers in human skin: a histological study. Dermatology 228(1):47–54

    Article  CAS  PubMed  Google Scholar 

  34. Taufig AZ, Szöke A, Kühnel W (2009) Neue Strategie zur Erfassung intradermaler Reaktionen nach Implantation resorbierbarer Dermalfiller. Journal für Ästhetische Chirurgie 2:29–36

    Article  Google Scholar 

  35. Sundaram H, Fagien S (2015) Cohesive Polydensified Matrix Hyaluronic Acid for Fine Lines. Plast Reconstr Surg 136(5 Suppl):149S–163S

    Article  CAS  PubMed  Google Scholar 

  36. Micheels P, Sarazin D, Besse S, Sundaram H, Flynn TC (2013) A blanching technique for intradermal injection of the hyaluronic acid Belotero. Plast Reconstr Surg 132(4 Suppl 2):59S–68S

    Article  CAS  PubMed  Google Scholar 

  37. Yoo DB, Peng GL, Massry GG (2013) Transconjunctival lower blepharoplasty with fat repositioning: a retrospective comparison of transposing fat to the subperiosteal vs supraperiosteal planes. JAMA Facial Plast Surg 15(3):176–181

    Article  PubMed  Google Scholar 

  38. Barone M, Cogliandro A, Salzillo R, Ciarrocchi S et al (2021) Midface Lift Plus Lipofilling Preferential in Patients with Negative Lower Eyelid Vectors: A Randomized Controlled Trial. Aesthetic Plast Surg 45:1012–1019

    Article  PubMed  Google Scholar 

  39. Barone M, Cogliandro A, Salzillo R, Persichetti P (2022) Emulation of the Midface Lift with Smiling in Patients with Negative Inferior Eyelid Vector. Aesthetic Plast Surg 46:2621–2622

    Article  PubMed  Google Scholar 

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Funding

None of the authors received any funding or financial support for the content of this article.

Author information

Authors and Affiliations

  1. Department of Facial Plastic and Cranio-Maxillo-Facial Surgery, Fakih Hospital, Khaizaran, Lebanon

    Nabil Fakih-Gomez, Juan Martin Zarate, Luis Miguel Lindo Delgadillo & Daniella Fakih

  2. ReSculpt Clinic, Practice for Aesthetic Dermatology, Amsterdam, The Netherlands

    Jonathan Kadouch

Authors
  1. Nabil Fakih-Gomez
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  2. Juan Martin Zarate
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  3. Luis Miguel Lindo Delgadillo
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  4. Daniella Fakih
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  5. Jonathan Kadouch
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Contributions

•Hypothesis / clinical observation: N.F.G., J.M.Z., J.K.

•Study design / methodology: N.F.G., J.M.Z., L.M.L.D., D.F.

•Research / data assessment: N.F.G., J.M.Z., L.M.L.D., D.F.

•Data analysis: N.F.G., J.M.Z., L.M.L.D., D.F.

•Writing of the paper: N.F.G., J.M.Z., L.M.L.D., D.F., J.K.

Corresponding author

Correspondence to Nabil Fakih-Gomez.

Ethics declarations

Ethics approval

Due to the retrospective and observational character of this study no ethical approval from a local ethics committee was solicited. All treatments were performed in adherence with the Declaration of Helsinki and in accordance with the standards of good clinical care following local guidelines and regulations.

Informed consent

All patients in the images within this manuscript provided written informed consent for sharing their pictures. All patients included in this study provided written informed consent for accessing their patients charts and extracting their data for the purposes of this study.

Conflict of interest

The authors N.F. and J.K. are both consultants for Merz Aesthetics (Frankfurt, Germany). Nabil Fakih-Gomez, Juan Martin Zarate, Luis Miguel Lindo Delgadillo, Daniella Fakih, and Jonathan Kadouch declare no conflict of interest.

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Fakih-Gomez, N., Zarate, J.M., Delgadillo, L.M.L. et al. Introducing the suborbital retaining ligament, subseptal, and retroseptal spaces: a novel technique for non-surgical correction of tear trough deformity. Eur J Plast Surg 47, 12 (2024). https://doi.org/10.1007/s00238-023-02143-4

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  • DOI: https://doi.org/10.1007/s00238-023-02143-4

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