Use of hyaluronic acid filler for tear-trough rejuvenation as an alternative to lower eyelid surgery

Ophthalmic Plast Reconstr Surg. Mar-Apr 2011;27(2):69-73. doi: 10.1097/IOP.0b013e3181b80f93.


Purpose: To describe one surgeon's experience with the use of hyaluronic acid gel (Perlane) as a tear-trough filler over an 18-month period and to assess patient satisfaction with the procedure.

Methods: Consecutive, interventional case series involving case note review, masked grading of clinical photographs, and patient satisfaction survey.

Results: A total of 198 eyes of 100 patients were treated, with a mean follow-up of 5.1 months. Patients were principally female (87%), white (89%), and middle-aged (mean age = 47.8 years). Eight percent had previous lower eyelid blepharoplasty, and one had thyroid orbitopathy. The gel was placed preperiosteally, deep to orbicularis, anterior to the inferior orbital rim, with a mean volume of 0.59 ml per eye. The injection procedure was tolerable in 95% of patients without local anesthetic. Side effects described by patients included bruising (75%), swelling (26%), blue discoloration (4%), and lumpiness (33%). However, only 7% required dissolution with hyaluronidase. Eight percent requested additional hyaluronic acid gel within 3 months. Mean downtime was 1 day. Most patients (85%) described marked or moderate satisfaction with the treatment, 5% were ambivalent, and 10% were dissatisfied.

Conclusions: This series confirms the effective use of hyaluronic acid gel (Perlane) in tear-trough rejuvenation. It has high patient tolerability, minimal complications, and high patient satisfaction. However, bruising, persistent lumpiness, or lack of perceived effect can lead to dissatisfaction in approximately 10% of cases.

MeSH terms

  • Adult
  • Aged
  • Cosmetic Techniques
  • Eyelids / drug effects*
  • Female
  • Gels / administration & dosage*
  • Humans
  • Hyaluronic Acid / administration & dosage*
  • Hyaluronic Acid / adverse effects
  • Injections / methods
  • Male
  • Middle Aged
  • Patient Satisfaction
  • Prospective Studies
  • Rejuvenation*
  • Retrospective Studies
  • Skin Aging / drug effects*
  • Young Adult


  • Gels
  • Hyaluronic Acid