Resumen

Objectives: The under eye area is delicate, and performing filler procedures with good results here is not surprisingly perceived as challenging. Five cases, four female and one male, with good results after filler injections in the tear trough area, will be presented. Four cases with complications, all female, will be presented and the learning outcomes of what might have led to the complications, will be discussed, to provide a better fundament for future treatments. Introduction: Filler procedures are a common aesthetic request, and with increasing numbers of injectors, both experienced and less experienced, more complications are being reported. The under eye area is anatomically challenging, and good results require a comprehensive understanding of the anatomy, correct injection technique, and choice of the right hyaluronic acid filler, which will be discussed by the author. Furthermore, necessary evaluations that need to be done in every patient before proceeding with injections in this area, will also be presented. Materials / method: Four female and one male patient received TT injections by the author. Sharp needles were used for the palpebromalar groove, and cannulas were used for the tear trough area. The male patient was followed up for 18 months. Evaluation of the results were based on the patients´ and author´s examination, pictures taken before and after, and the Tear Trough Rating Scale. Four other cases with different types of tear trough complications were treated, one with migrated filler, one with incapsulated filler (verified by biopsy) and one with filler placed in the wrong anatomical layer. Results: Visible improvement in hollowness and and skin quality, also according to the Tear Trough Rating Scale, was accomplished in all of the five patients that was injected by the author. The male patient was followed up for 18 months with no need for touch ups. Three of the four patients with complications were treated with with successful results. The patient with incapsulated filler received several treatments, with good, but not complete resolving of the complication. No serious adverse reactions were reported. Conclusion: A comprehensive understanding of the anatomy, correct injection technique, and choice of the right hyaluronic acid filler are three mandatory pillars for successful, long term injection results of the tear trough area. If one of the pillars are missing, the fundament will be weak, and complications might occur, like migration, nodules and under eye bags. Correct injection knowledge and updated complication management are crucial for high quality results and a safe outcome.