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Treatment of Tear Trough Deformity and Lower Lid Bowing with Injectable Hyaluronic Acid

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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.

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References

  1. 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

    Article  Google Scholar 

  2. 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

    PubMed  Google Scholar 

  3. Coleman S: Avoidance of arterial occlusion from injection of soft tissue fillers. Aesth Surg J 22:555, 2002

    Article  Google Scholar 

  4. Coleman S: Periorbital rejuvenation. Aesth Surg J 21:337, 2001

    Article  Google Scholar 

  5. Flowers RF: Tear trough implants for correction of tear trough deformity. Clin Plast Surg 20:403–415, 1993

    PubMed  Google Scholar 

  6. Goldberg RA: Transconjunctival orbital fat repositioning: Transposition of orbital fat pedicles into a subperiosteal pocket. Plast Reconstr Surg 105:743–748, 2000

    PubMed  Google Scholar 

  7. Hamra S: Arcus marginalis release and orbital fat preservation in midface rejuvenation. Plast Reconst Surg 96:354–362, 1995

    PubMed  Google Scholar 

  8. 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

  9. 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

    Google Scholar 

  10. Hester TR, Codner MA, McCord CD, Nahai F: Transorbital lower lid and midface rejuvenation. Oper Tech Plast Reconstr Surg 5:163, 1998

    Google Scholar 

  11. 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

    Article  PubMed  Google Scholar 

  12. Hylaform Product Insert 2004

  13. Kawamoto HK, Bradley JP: The tear “trouf” procedure: Transconjunctival repositioning of orbital unipedicled fat. Plast Reconstr Surg 112:1903–1907, 2003

    Article  PubMed  Google Scholar 

  14. Klein AW: Personal communication, November 2004

  15. Lee S, Isse N: Barbed polypropylene sutures for midface elevation: Early results. Arch Facial Plast Surg 7:55–61, 2005

    Article  PubMed  Google Scholar 

  16. Levine RA, Garza JR, Wang PT, Hurst CL, Dev VR: Adult facial growth: Applications to aesthetic surgery. Aesth Plast Surg 27:265–268, 2003

    Article  Google Scholar 

  17. Louarn CL: The concentric malar lift: Malar and lower eyelid rejuvenation. Aesth Plast Surg 28(6):359–72, Nov–Dec 2004

    Article  Google Scholar 

  18. Lucarelli MJ, Khwarg SI, Lemke BN, Kozel JS, Dortzbarch RK: The anatomy of midfacial ptosis. Ophthal Plast Reconstr Surg 16:7, 2000

    Article  PubMed  Google Scholar 

  19. 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

    Article  Google Scholar 

  20. 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

    Article  PubMed  Google Scholar 

  21. Seiff SR: The fat pearl graft in ophthalmic plastic surgery. Orbit 21:105–109, 2002

    Article  PubMed  Google Scholar 

  22. 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

  23. 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

  24. Wortzman M: Personal communication, March 2005

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Authors and Affiliations

  1. Manhattan Eye, Ear, and Throat Hospital, 630 Park Avenue, New York, NY, 10021, USA

    Michael A. C. Kane M.D.

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  1. Michael A. C. Kane M.D.
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Correspondence to Michael A. C. Kane M.D..

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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

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  • DOI: https://doi.org/10.1007/s00266-005-0071-7

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