How Can Tear Trough Injections Be Done Safely And Effectively?

Q: Dr. Eppley, I am interested in getting injectable fillers into my tear troughs (tear trough injections) but am very nervous about it. I have read numerous horror stories of significant bruising and clumps and irregularities in this area. What is the best way to inject the tear troughs and not have these problems?

A:  Injections for tear trough (nasojugal) effacement is the most technique sensitive of all injectable filler treatments of the face. I used to use a 1/2 inch 30 gauge needle and injected down to the level of the periosteum along the medial orbital rim. But the periosteum over the orbital rim is quite adherent and recent studies have shown that the periosteum and the retaining ligaments in this area are very difficult to elevate and are prone to bleeding and external bruising.

I have subsequently changed my tear trough filler technique to using a microcannula rather than a needle. Coming though the thicker cheek skin rather than the thinner eyelid skin, I enter the submuscular plane above the periosteum to inject. This approach puts the microcannula directly into the tear trough and has no risk of causing bleeding or bruising afterwards. This more superficial submuscular deposition of filler has improved my results dramatically. In addition, the entire tear trough can be filled from a single puncture in the upper cheek. The microcannula can reach the most medial part of the tear trough.

It is important when filling the tear trough to only use hyaluronic acid-based fillers to avoid clumping and to not overfill. Less is more when it comes to filling the tear troughs.

Dr. Barry Eppley

Indianapolis, Indiana