Figure - available from: Journal of Cosmetic Dermatology
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Type 3: Treatment plan and results. A 44‐year‐old woman who presented with a type 3 defect, shown at rest (A, B, C) and when smiling ((D); demonstrating greater prominence of the eye bags). In profile view, she showed a negative vector (E). The treatment plan was based on (1) filling the deep fat compartments (DMCF, shown in blue in part (F); SOOF, yellow; pre‐maxillary space, red); (1) filling the depression in the tear trough and the palpebromalar groove region (shown in green in part (F)); and (3) placing a small amount of filler in the preseptal space (shown in purple in part (F)). To achieve this, Juvéderm Voluma was used in the deep fat component (0.5 ml per side) and Humallagen was injected into the tear trough, palpebromalar groove region, and preseptal space (right side, 0.8 ml; left side, 0.8 ml). The result at 1‐month post‐treatment is shown at rest (G, H, I) and when smiling (J). DMCF, deep medial cheek fat; SOOF, suborbicularis oculi fat.
Source publication
Background:
Tear trough depressions are widely treated with fillers. However, it is questionable whether the same strategies can always be used for Caucasian and Japanese patients, owing to differences in bone and skin structures and epithelial thickness.
Aims:
To assess a novel classification system and treatment algorithm for correcting tear t...
Citations
Background
Despite increasing popularity, the use of hyaluronic acid (HA) fillers for the correction of dark under eye shadows remains challenging. Specific guidance on patient assessment is limited.
Objectives
To develop a stepwise assessment framework for lower eyelid dark shadows to help practitioners to classify patients based on their underlying problems and facilitate a more strategic approach to treatment.
Methods
Literature review and peer collaboration informed the current availability of educational material for use by experienced injectors when assessing patients presenting with dark circles. A practitioner survey provided insight into current practices. A focus group convened to review the survey results and discuss best practice approaches to patient assessment.
Results
Surveyed practitioners (n = 39) reported patient concern about under eye hollows (91%), dark eye circles (80%) and looking tired (60%). All (100%) agreed that mid-cheek volume was critical when treating tear trough depression, only 26% reported use of a tear-trough classification system. The focus group developed a framework for assessing tear trough depression and the lid-cheek junction in patients presenting with dark circles. Key factors within this framework include the importance of appropriate lighting when conducing a visual inspection, regional inspection of the cheek and tear trough, palpation of the orbital rim and soft tissues, determination of the orbital vector and assessment of lower eyelid pigmentation/skin quality.
Conclusions
Careful step-by-step assessment can reduce the challenges of treating dark circles by identifying patients in whom dark eye circles may be improved without the need to directly inject filler into the tear trough.
Since aesthetic medical treatments providing natural results are becoming increasingly popular, we developed an innovative hyaluronic acid infiltration technique for midface rejuvenation.
In this prospective study, only patients with a negative or neutral lower eyelid vector were included.
Treatment consisted in injecting three hyaluronic acid boluses at the cutaneous projections of the levator labii superioris, zygomatic major and minor muscles insertions. All patients were administered before treatment the FACE-Q questionnaire, whereas after treatment, they were administered the FACE-Q questionnaire and the Global Aesthetic Improvement Scale (GAIS). All treatments were documented with standardized photographs. A plastic surgeon from another Institution reviewed the photos and scored the treatments according to the GAIS scale.
We included 567 patients (101 males and 466 females) who met the inclusion criteria. The mean age was 41 years, and mean follow-up time was four months. The FACE-Q scores after treatment were significantly higher (p < 0.001) in every domain investigated. The GAIS scores demonstrated significant improvement posttreatment in 89.8% of patients. An average of 1.5 ml of hyaluronic acid (VYC-20) was used for each zygomatic region. No major complications were reported; only 27 patients reported bruising, which resolved spontaneously. In all patients, there was an inversion of the lower eyelid vector, which had transitioned from neutral or negative to positive.
Lifting the insertions of three selected muscles with hyaluronic acid allows a midface upward repositioning. This technique provides a reproducible and safe approach for midface rejuvenation through tissue repositioning rather than augmenting facial volume.
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Background
Non-surgical correction of tear trough deformity using dermal fillers poses multiple challenges even in experienced hands. Herein, a retrospective study of patients treated using a novel technique for the correction of this deformity is presented.
Methods
The review of tear trough deformity anatomy and classification, patient assessment, and injection technique is performed. This technique introduces the suborbital retaining ligament, subseptal, and retroseptal spaces, along with a consistent and reproducible method for their precise identification using a micro cannula.
Results
From September 2019 until September 2021, a total of 310 patients and 620 tear troughs were treated with this technique. The average volume of filler used was 0.35 cc (0.2–0.5) per eye. Patients required a median (IQR) of 2 (1–3) treatment sessions. Overall patient satisfaction was high in the vast majority of patient, with no serious complications reported.
Conclusions
Adoption of this novel concepts may aid practitioners for precise placement of the fillers in specific anatomical spaces according to the type of deformity, providing optimal results while reducing complications.
Level of evidence: Level IV, therapeutic study
