What are tear troughs?

The tear troughs refer to a fold extending from the inner eye corner, extending downward and outwards and causing hollowing or dark shadows under the eyes, or in severe cases, the appearance of eye bags. Tear troughs can make us look tired even after we’ve had enough sleep, and can make us look older than we are. Cosmetics can help disguise the tear troughs in women, but if it bothers you, it can be corrected non-surgically using dermal fillers such as hyaluronic acid. This procedure uses tiny injections of filler and takes about twenty minutes and the results can last well over a year or more.

Why do tear troughs form?

As we age, there are gradual changes taking place in our faces and especially around our eyes. The changes happen in all the layers of the face, including skin, fat, muscle, and bone. Firstly the delicate skin around the eyes is vulnerable to sun damage and can develop fine lines and wrinkles and become “crepey” in texture. There is a natural slow decrease in fatty tissue under the lower eyelid and upper cheek area.  The muscles of the lower lid slowly lose elasticity and no longer remain tightly tethered in place. Also the cheekbone and eye socket shapes are slowly receding over time to result in a lack of bony support for the skin. The rates that these changes happen vary a lot in different people, and are also linked to smoking, stress, skincare, sun exposure, body weight, and genetics. These changes can eventually cause the tear trough depression to become puffy or bulge away from the face (pseudo herniation of the infraorbital fat pads).  When the tissue under the eye pushes outward, ‘bags’ begin to develop.  The unevenness of the area can become shadowy, which in turn will look like ‘dark circles’ under the eyes.  No matter how much makeup is worn, the face can still looked exhausted and drawn.

How are tear troughs corrected?

Unsightly tear troughs can be efficiently corrected without surgery for both men and women.  Using tiny injections of hyaluronic acid dermal filler, a significant improvement for tear troughs can be achieved.  Soft fluid dermal fillers, comprised of hyaluronic acid, will gently fill the tear trough depression, making it look smoother and healthier.  With the area no longer sunken, the dark ‘circles’ are reduced, as the thin skin in this area is highly reflective and shadowing is reduced when the hollowness is corrected with fillers.  Best of all, the results from this treatment will be immediate.  Patients leave the clinic looking refreshed, rejuvenated, even years younger.

What is hyaluronic acid?

Hyaluronic Acid (HA) is a natural form of sugar which is found in our skin, joints and tissues. It helps the skin stay fresh and hydrated and binds with water to help plump up skin and keep it young and healthy looking. Some face creams contain hyaluronic acid which do help to hydrate the surface layers of the skin, but for volumising or sculpting, the hyaluronic acid need to be injected.

Is the treatment painful?

No, it is very well tolerated. We use a numbing cream first to reduce discomfort. The fillers contain lidocaine which also reduces discomfort and Dr Brenner uses an ice pack to help too. She also uses a soft gentle type of needle called a cannula which reduces the discomfort, and reduces the risk of bruising and swelling. The cannula feels like a small pinch and there can be mild discomfort but most people find it much easier than they expected!

What will I look like immediately after treatment?

The tear troughs will look better immediately and continue to improve over the following few weeks. It is important that we don’t put too much filler in the tear troughs to avoid puffiness, so we treat carefully and conservatively, and can add more if needed a few weeks later(at an additional cost). You will look a bit red and may be slightly swollen in the treated area and there is a small risk of a bruise with any injection on the face. Dr Brenner will apply concealer to minimise redness or you can bring your own make-up if you prefer (please make sure it is a new product to reduce the risk of infection from bacteria in open products and please ensure any make-up brushes or sponges are clean too!). This is because there are tiny needle marks after treatment and we don’t want any bacteria getting into the skin while the needle marks are there. Bear in mind that the filler will last 12 months or longer, so these hygiene measures are essential in the first four hours after treatment.

For the first four hours after the injections, you are encouraged to remain upright, to allow the filler to settle.  Strenuous activity and exercise should be postponed for 24 hours.  No swimming goggles should be worn for 24 hours nor should heavy glasses or sunglasses that press on the skin around the eyes. Makeup can be worn the following day.  It is important that you avoid tanning, chemical peels, or facials of any kind for five to seven days, as the tissues will be very sensitive.  Patients can expect mild swelling and redness at the injection site over the first few days after their injections.  Cold compresses can be used to keep down the any swelling.  These side effects will dissipate over the first week.

Who is suitable for treatment?

While tear troughs normally appear in the 30s or 40s, people as young as 20 may begin to notice this early sign of aging.  The ideal candidate for tear trough correction is anyone who understands the procedure, is in generally good health, and holds realistic expectations for their results. 

The initial 45 minute appointment with Dr Brenner will provide an opportunity for an evaluation, a review of the medical history, and a discussion of the options and desired results.  If you are happy to, you can go ahead with the treatment then, or you can go home and have a think about it. There is never any pressure to proceed with treatment. We will never suggest a treatment that we do not think you will benefit from. If you decide to proceed, Dr Brenner will take photographs (which are kept strictly private), ask you to sign a consent form, and will provide aftercare instructions and a contact mobile number for aftercare.

What other options are available to treat tear troughs?

During your consultation Dr Brenner will assess your skin and concerns and may suggest treatments besides dermal fillers. Some of these include skincare, including retinol products which can build collagen, SPF creams to protect the skin, micro-needling which also stimulates collagen and reduces lines and wrinkles, and in some cases may suggest surgical referral to consider blepharoplasty (eye lid surgery), if eye-bags are severe and would not be suitable for fillers. Tear troughs do not impact your general health, although they can reduce self-confidence, so in many people, correction is really worthwhile.

What are the risks with fillers in this area?

This area is delicate and this treatment needs a highly skilled and experienced doctor to do this treatment. Dr Brenner has several years’ experience doing this treatment with hundreds of patients and achieves natural, safe, excellent results. The common risks include bruising, swelling, redness and discomfort. These can last a few days but are mild and well-tolerated. There may be no bruising whatsoever, but we still don’t recommend this treatment in the week before a wedding or special event in case of bruising/swelling. More rare complications include infection, or uneven results. Dr Brenner will discuss risks and benefits at your appointment. In inexperienced hands, if the filler is placed too superficially it can result in lumps or a bluish discolouration (Tyndall effect) from light reflection through the filler, so it is vital to seek a highly trained doctor to do this work.

Is the filler reversible?

Yes, all hyaluronic acid fillers are reversible with an injection of a dissolving agent called hyalase. This can give peace of mind for you in the highly unlikely situation that you don’t like the results of dermal filler treatment. Dr Brenner has experience in using hyalase for clients who have had over filled lips or “over done” work elsewhere. Injection with hyalase will dissolve the hyaluronic acid filler in less than 24 hours, even if the filler treatment was done weeks or months previously. Hyalase does not dissolve other dermal fillers, for example Radiesse, Ellansé, or Sculptra.

How much does it cost?

Hyaluronic acid filler in the tear troughs costs on average €395-495 for both eyes, depending on how much product is needed and which product is used. You will be advised of the cost before any treatment. We never “over-fill” tear troughs as this area is prone to puffiness, so we generally “under-correct” or “under-treat” a little, allowing for the filler to settle in, and also so that we can add more at a later date if needed (at additional cost). Less really is more in this area!