Objectives: The tear trough should be slightly under filled to get a more pleasing aesthetic outcome. Also, excessive filling in this area causes many problems that are difficult to treat. Anatomy knowledge of the area alongwith a good understanding of the physical characteristics helps in preventing as well as dealing with the complications
Introduction: Hollowness around the eyes gives the impression of big eyes. Indians , in general have a more recessed infraorbital rim than other ethnic groups. However, the obsession with under eye grooves and the eagerness of most injectors to flatten out all grooves has given rise to an aesthetically apparent and unpleasant impression of the infraorbital region.
Also, this has resulted in excessive filler deposition, and excessive attempts to mould and massage the infraorbital region has resulted in filler migrating to areas where we never intended them to go.
Materials / method: The detailed anatomy of the tear trough region was reviewed , patients opinion was noted. Techniques were reviewed regarding whether the tear trough was either minimally filled or fully filled. Also, HA fillers which were initially available were quite hygroscopic, and a satisfactory correction was found to be bulging after 4 weeks of injection. Also, Tyndall effect was commonly seen.
Results: The overfilled ones were partially hyalased, and a better understanding of the anatomy as well as behavior of the filler helped us deal with the complications associated with overfilling viz. malar edema, migration into the orbit & lower eyelid .
The tendency to completely efface the infraorbital region does not produce an aesthetic outcome.
The infraorbital region is particularly known to retain HA filler for years altogether, and therefore can still be treated effectively years later.
Also complications resulting from excessive filling in this region is fraught with complications.
Conclusion: To obtain an aesthetic result , the tear trough should be filled very conservatively. A detailed knowledge of anatomy of the tear tough area, as well as good knowledge of the filler characteristics is necessary to minimise / treat complications.
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