Background: The tear trough, though small in physical dimensions, sits at the perceptual epicenter of the face. Because small changes here make large changes in how other people interpret one's state of being, it would be beneficial to have a simple way of addressing the area. Despite the complexities of cause, the solution is to level the hollow and smooth the junction between the lid and the cheek.
Methods: Hyaluronic acid injections are used to address the tear trough deformity. Very small quantities, 0.2 to 0.4 cc, are used per side, and the placement is in the orbicularis oculi muscle or at the periosteum. The key is to inject deep to the dermis and to massage the injected area smooth.
Results: All patients were improved roughly in proportion to their skin quality. The best patients for the treatment are those with young, thick skin and a definite hollow. The duration of the effect is often more than 1 year at this location. Minor bruising and irregularities were self-limiting or treated with light massage. Large overfills or irregularities are correctable with injection of hyaluronidase.
Conclusions: Tear trough injection with hyaluronic acid products is relatively simple, effective, and safe, and can offer significant improvement in this difficult area. It can be performed for primary deformities or to improve a surgical result.