Tear trough rejuvenation: A safety evaluation of the treatment by a semi-cross-linked hyaluronic acid filler

Orbit. 2017 Feb;36(1):22-26. doi: 10.1080/01676830.2017.1279641. Epub 2017 Jan 25.


The aim of this study is to describe the experience of 33 physicians, dermatologists and surgeons, with the use of a semi-cross-linked hyaluronic acid (HA) gel as a tear trough deformity filler within one month following injection, and to assess patient satisfaction with the procedure. This study is a case series conducted between February 2012 and December 2012 with the use of semi-cross-linked HA to correct tear trough deformity. The filler was administered in the preperiosteal tissues. The study involved case note review and a patient satisfaction survey. A total of 302 eyes of 151 patients were treated by 33 physicians, with a mean follow-up of 3 weeks. Patients were mainly female (86%), and middle-aged (mean age 48 years old). The gel was placed preperiosteally, deep to the orbicularis, anterior to the inferior orbital rim, with a mean volume of 0.48 ml per eye to achieve correction. The injection procedure was performed without local anesthetic for 79% of the patients. No serious adverse event was recorded. Side effects reported by investigators immediately after injection included bruising (11%), swelling (12%), and redness (inflammation 12%). Very few transitional blue discolorations (2.6%) were observed. No patient required dissolution with hyaluronidase. According to our satisfaction survey, all patients had cosmetic improvement. Most patients (97%) described marked or moderate satisfaction with the treatment. At one month, 18% requested additional hyaluronic acid gel for a touch-up injection. This case series confirms the effective use of a semi-cross-linked HA gel in tear trough rejuvenation. It has excellent patient tolerability, minimal complications, and excellent patient satisfaction.

Keywords: Cosmetic medicine; hollow ring; hyaluronic acid fillers; non-invasive facial rejuvenation; tear trough.

Publication types

  • Clinical Trial
  • Multicenter Study

MeSH terms

  • Cosmetic Techniques
  • Dermal Fillers / administration & dosage*
  • Dermal Fillers / adverse effects
  • Female
  • Humans
  • Hyaluronic Acid / administration & dosage*
  • Hyaluronic Acid / adverse effects
  • Injections, Subcutaneous
  • Lacrimal Apparatus / drug effects*
  • Male
  • Mesotherapy
  • Middle Aged
  • Patient Satisfaction / statistics & numerical data
  • Prospective Studies
  • Rejuvenation*
  • Skin Aging / drug effects*
  • Viscosupplements / administration & dosage*
  • Viscosupplements / adverse effects


  • Dermal Fillers
  • Teosyal 27G Deep Lines
  • Viscosupplements
  • Hyaluronic Acid