Why tear troughs are the hardest area in the face to fill

Article medically reviewed by Dr. Gavin Chan

Templestowe Lower, Berwick and Beaumaris Clinics

Dr. Gavin Chan, MBBS, General Registration (MED0001175745), founder of the Victorian Cosmetic Institute, began offering cosmetic medical treatments in 2004. Formerly a trainer for cosmetic pharmaceutical companies, Dr. Chan currently concentrates on offering ongoing training to cosmetic doctors at the Victorian Cosmetic Institute. He ensures that all doctors stay updated with the latest procedures and methods in the cosmetic industry. Read More

When you look in the mirror, your eyes are generally the first things you see. If the hollows and bags under your eyes are making you look tired and old, you may be considering dermal filler treatment. While the area under your eyes, called ‘tear troughs’, can be effectively improved using dermal filler treatment Dr Gavin Chan (MBBS, Cosmetic Doctor, Liposuctionist) cautions that it’s a difficult area to treat.

Dr Gavin Chan explains issues with tear trough treatment include:

• Overfilling of under eye area with dermal filler
• Puffiness of under eye area
• A blue-grey discolouration under the eye skin
• A ‘worm-like’ appearance under the eyes
• Inappropriate positioning of the dermal filler.

The tear trough area is hard to treat because due to the thin skin under your eyes. This area also has less fat to cover any fillers that may are used in that area. Dermal fillers have a hydrophilic nature, which means they expand and attract water. Dr Gavin Chan explains, “The amount of dermal filler you inject in the first instance may not necessarily reflect the final result that you see in a few weeks because of the expansion of filler.

It can be difficult for your Cosmetic Doctor or Cosmetic Nurse to judge precisely how much dermal filler to use in the tear trough area because what you see in the first instance is not what you always get as the final result. The tear trough area is highly prone to bruising, primarily where needles are used to inject filler. If your skin starts to bruise in the middle of a tear trough filler procedure, the Cosmetic Doctor or Cosmetic Nurse can’t see what they’re doing.

Treating tear troughs with dermal filler is hard because of the challenge of determining the underlying anatomy. Your surface anatomy is the only way to decide where to use dermal filler injections.

How to fill tear troughs effectively

Dr Gavin Chan notes that before dermal filler treatment starts, it’s essential that your Cosmetic Doctor or Cosmetic Nurse analyses which type of tear trough you have. There are two types of tear troughs with each requiring different treatment protocols with varying kinds of filler.

The first types of tear troughs are usually more of a genetic problem and are called ‘true tear troughs’. Dr Gavin Chan explains, “In true tear troughs skin is attached to underlying skin and bone. This usually starts in the teenage years, is genetic and isn’t related to the ageing process.”

The other types of tear troughs are called ‘pseudo tear troughs’ and are characterised by the mid-face thinning to reveal the bony orbital rim. Dr Gavin Chan says, “pseudo-tear troughs occur as a result of volume loss from the mid cheek area. They can also become evident where a loss of fat, the effect gravity or the ageing process reveals a hollow under the eye.” Once your Cosmetic Doctor or Cosmetic Nurse has identified which tear trough you have, they can then choose the correct dermal filler technique.

For pseudo tear trough treatment, Dr Gavin Chan suggests they’re, “corrected by filling the mid cheek to support all the underlying structures of the lower eyelid. The lift and support from the dermal filler will eliminate the lower eyelid hollowness.” A more in-depth injecting technique into the mid cheek is used with this type of tear trough. This requires using dermal filler that’s not too fine or liquid.

Real tear troughs need to be treated with a different type of filler. Dr Gavin Chan explains, “We need to get the dermal filler ‘sandwiched’ in between the skin and the muscle. It needs to be fine dermal filler which doesn’t swell too much and which can blend in well. True tear trough filling requires a finer filler directly in the tear trough hollow”.

It’s important to note that some patients will have both types of tear troughs present. This highlights the importance of having tear trough treatment with dermal filler at a reputable medical clinic that has highly trained and experienced professional practitioners. Led by Dr Gavin Chan, our team of Cosmetic Doctors and Cosmetic Nurses always choose to underfill rather than overfill tear troughs. View our before and after gallery of tear trough patients.

Why cannulas are the best way to fill the tear trough area

While many clinics still fill the tear troughs by making multiple injections under the eye with a needle, Dr Gavin Chan and his team of Cosmetic Doctors and Cosmetic Nurses prefer to use a blunt tipped cannula. Dr Gavin Chan explains, “A cannula is like a needle, but it has a rounded tip that’s inserted into the skin after a small needle has made an entry point. The cannula can go through the tissue without piercing or cutting through any veins which leads to less bruising.”

Before you undergo tear trough treatment, it’s essential to consider whether the practitioner will use cannulas or needles. Dr Gavin Chan notes, “Cannulas, in my opinion, are the way to go for tear trough filling. They’re infinitely harder to use than needles because it takes a lot more skill to inject with the cannula.”

Are you the right candidate for tear trough filler treatment?

Since the tear trough area is a hard area to treat with dermal filler, it’s important that you’re the right patient for this treatment. People who are not the right candidate for tear trough filler treatment have:

• Overly crepey, wrinkly or loose skin under the eyelid.
• A sizeable fat bulge under your eyes. If you have this condition, the fat will need to be removed surgically.
• A hypertrophy orbicularis oculi, a roll of muscle underneath your eye. Sometimes this muscle is mistaken as a tear trough.

Aside from medical considerations, it’s vital that your expectations about tear trough filler are achievable. Dr Gavin Chan and his team of Cosmetic Doctors and Cosmetic Nurses believe that one of the most important things to do when treating tear troughs is to under fill. He notes, “It’s natural to have some hollows under your eyes, and it gives us some margin for fluctuations with the filler.”

The best skincare to use after tear trough treatment

After you’ve had tear trough treatment with dermal fillers, it’s important to use skincare that nourishes, protects and hydrates your delicate eye area. Biopelle Tensage Eye Contour Cream 15g is a lightly textured eye cream that firms and tightens while improving the elasticity of your sensitive eye area. Formulated with unique SCA Technology, it boosts collagen and elastin production while supporting healthy dermal cell regeneration. Ideal for night use, this eye contour cream also improves the appearance of crepey skin under the eyes. Cosmedix Elite Eye Doctor 7ml is a liquid crystal, age-defying eye serum that improves the appearance of thinning, damaged skin around your eyes. A combination of free radical-fighting antioxidants, Retinol and botanical ingredients help protect your skin from environmental stress and reduce inflammation. The rich conditioning moisturisers help attract and retain vital moisture around your delicate eye area.

Aspect Dr Eyelift 15ml is a hydrating soothing eye cream that reduces the appearance of puffiness, dark under eye circles, eye bags and crow’s feet. With antioxidant protection, this eye cream is suitable for all skin types. Need some help with your skincare choices? Our highly trained and experienced Skin Therapists can help you with a skincare regime that achieves optimal results. Call us on 1300 863 824 to book your skin consultation.

Where to get the best tear trough dermal filler treatment in Melbourne     

Are your tear troughs giving an impression that you’re older and more tired than you feel? If you’re a suitable candidate, tear trough treatment with dermal filler is an effective non-surgical treatment. Led by Dr Gavin Chan and his team of highly experienced and trained Cosmetic Doctors and Cosmetic Nurses have successfully treated thousands of people’s tear troughs with dermal filler treatments since 2005. Find out how we can smooth away your tear troughs to give your eyes a fresher look. Call our friendly customer service team on 1300 863 824