Abstract
Tear trough deformity of the lower eyelid is one of the most difficult depressions to correct surgically. The thin skin of the trough, the overhanging abundant lower lid fat, the underlying cheek mound, and the tethering effect of the orbitomalar ligament create a surgical challenge. Until now, noninvasive methods used to treat this depression have been problematic, yielding a poor benefit-to-risk ratio in most hands. Even surgery does not completely manage this depression. The most common surgical techniques for lower eyelid rejuvenation do not even address it. Since December of 2003, 24 patients have had their tear troughs treated with injectable hyaluronic acid. For 23 patients, Restylane was injected superficially to elevate the surface from the orbitomalar ligament and add volume to the trough. Only two patients were dissatisfied with their results.
Similar content being viewed by others
References
Atiyeh BS, Hayek SN: Combined arcus marginalis release, preseptal orbicularis muscle sling, and SOOF placation for midfacial rejuvenation. Aesth Plast Surg 28:197–202, 2004
Barton FE Jr, Ha R, Awada M: Fat extrusion and septal reset in patients with the tear trough triad: A critical appraisal. Plast Reconstr Surg 113:2115–2121, 2004
Coleman S: Avoidance of arterial occlusion from injection of soft tissue fillers. Aesth Surg J 22:555, 2002
Coleman S: Periorbital rejuvenation. Aesth Surg J 21:337, 2001
Flowers RF: Tear trough implants for correction of tear trough deformity. Clin Plast Surg 20:403–415, 1993
Goldberg RA: Transconjunctival orbital fat repositioning: Transposition of orbital fat pedicles into a subperiosteal pocket. Plast Reconstr Surg 105:743–748, 2000
Hamra S: Arcus marginalis release and orbital fat preservation in midface rejuvenation. Plast Reconst Surg 96:354–362, 1995
Hester TR, Codner MA, McCord CD: Subperiosteal malar cheek lift with lower blepharoplasty. In: Eyelid surgery: Principles and techniques. Lippincott-Raven: Philadelphia, p. 210, 1995
Hester TR, Codner MA, McCord CD: The centrofacial approach for correction of facial aging using the transblepharoplasty superperiosteal cheek lift. Aesth Surg J 16:51, 1996
Hester TR, Codner MA, McCord CD, Nahai F: Transorbital lower lid and midface rejuvenation. Oper Tech Plast Reconstr Surg 5:163, 1998
Hester TR, Codner MA, McCord CD, Nahai F, Giannopoulos A: Evolution of technique of the direct transblepharoplasty approach for the correction of lower lid and midfacial aging: Maximizing results and minimizing complications in a 5-year experience. Plast Reconst Surg 105:393, 2000
Hylaform Product Insert 2004
Kawamoto HK, Bradley JP: The tear “trouf” procedure: Transconjunctival repositioning of orbital unipedicled fat. Plast Reconstr Surg 112:1903–1907, 2003
Klein AW: Personal communication, November 2004
Lee S, Isse N: Barbed polypropylene sutures for midface elevation: Early results. Arch Facial Plast Surg 7:55–61, 2005
Levine RA, Garza JR, Wang PT, Hurst CL, Dev VR: Adult facial growth: Applications to aesthetic surgery. Aesth Plast Surg 27:265–268, 2003
Louarn CL: The concentric malar lift: Malar and lower eyelid rejuvenation. Aesth Plast Surg 28(6):359–72, Nov–Dec 2004
Lucarelli MJ, Khwarg SI, Lemke BN, Kozel JS, Dortzbarch RK: The anatomy of midfacial ptosis. Ophthal Plast Reconstr Surg 16:7, 2000
Moelleken B: The superficial subciliary cheek lift: A technique for rejuvenating the infraorbital region and nasojugal groove: A review of 71 patients. Plast Recons Surg 104:1863–1874, 1999
Sasaki GH, Cohen AT: Meloplication of the malar fat pads by percutaneous cable-suture technique for midface rejuvenation: Outcome study. Plast Reconst Surg 110:635–654, 2002
Seiff SR: The fat pearl graft in ophthalmic plastic surgery. Orbit 21:105–109, 2002
Sullivan PK: The anatomic basis for the tear trough and crescent deformity at the lower eyelid-cheek junction. Plastic Surgery 2003. San Diego, CA. Oct 28, 2003
Sullivan PK, Kim R: Treatment of the lower eyelid tear trough and lid cheek junction abnormality using a transconjunctival retroseptal approach with fat transposition and internal continuous suture fixation. The Aesthetic Meeting, Vancouver, Canada, 17 April 2004
Wortzman M: Personal communication, March 2005
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kane, M.A.C. Treatment of Tear Trough Deformity and Lower Lid Bowing with Injectable Hyaluronic Acid. Aesth Plast Surg 29, 363–367 (2005). https://doi.org/10.1007/s00266-005-0071-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00266-005-0071-7