Dermal fillers for tear trough treatment

IIWAM - International Institute of Wellness & Aesthetic Medicine is a One-Stop Centre of Excellence in Wellness & Aesthetic Medicine that provides Education, an Online Library & Learning Portal, and Advanced Cosmetic Procedures. IIWAM is destined to be the Future of Aesthetic Medicine.

IIWAM Aesthetic Education (previously known as Aesthetic Academy Asia) provides evidence-based Aesthetic Medical courses with Dual International Certificates for Medical Doctors, Dentists, Nurses & Certified Aestheticians.

In a recent article, we spoke about how correcting nasolabial fold & marionette lines using dermal filler.

(Read the blog here- Nasolabial Fold & Marionette Lines Using Dermal Filler)

In today’s article, we will help to educate you, how effective dermal fillers are for tear trough treatment.

What is tear trough deformity?

Tear trough is a natural consequence of ageing, loss of soft tissue around the periorbital area and, most importantly the loss of osseous support that leads to a sunken appearance of the under eye, casting a dark shadow over the lower eyelid, resulting in a fatigued appearance of an individual, even after adequate rest. Anatomically, descent of the cheek, loss of facial volume, underdevelopment of the infraorbital malar complex and a muscular defect between the orbicularis muscle and angular head of the quadratus labii superioris muscle, all lead to the formation of tear trough deformity.

Most people in their middle ages seek periorbital rejuvenation. Due to this, various treatment options have evolved over time to address this issue. More recently, aesthetic practitioners rely on volume restoration as the preferred treatment option. The objective is to have a smooth transition of the lower eyelid between the pre-septal and orbital portions of the orbicularis oculi muscle, so it continues into the upper malar region without a definable transition point.

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Treatment using Dermal fillers

Dermal fillers are injectables that are completely biodegradable, biocompatible, and 100% natural. They are injected beneath the skin to restore lost volume, smoothen lines, soften creases, or enhance facial contours. The most commonly used dermal fillers are made from cross-linked hyaluronic acid (HA). They are temporary and reversible. With the advancement in technology, and depending on the type, fillers are capable of lasting effectively up to twelve months at a time. Hyaluronic acid (HA) based fillers are currently a popular technique for tear trough deformity treatment as they have substantially decreased allergic reactions as compared to other methods.

(Also read: Thread Lifts for Non-Surgical Face Lifts )

Procedure for tear trough treatment using fillers

In the tear trough treatment procedure, the area of treatment is thoroughly cleaned with chlorhexidine and normal saline after which it’s numbed using ice cubes and then examined again. Since the tear trough area is prone to significant bruising due to the rich subdermal vascular plexus, the point of insertion of the needle is kept about 1.5 cm below the orbital rim in line with the midpupillary line.

Using a 30-gauge needle, cross-linked Hyaluronic acid with lignocaine is injected diagonally up towards the medial canthus and plunged deep into the skin through the muscle right up to the periosteum. The filler is deposited subperiosteally to a visual end point of optimal correction, all through which the aesthetic practitioner continuously keeps massaging the infraorbital rim with the noninjecting hand to ensure complete protection. The needle is slowly withdrawn but the filler is not injected while the needle is being withdrawn, as superficial injections are bound to give a Tyndall effect in this area. The direction of the needle is then changed vertically up towards the midpupillary line and plunged again into the periosteum. Another depot injection is given. A third injection is given subperiosteally and diagonally up towards the lateral canthus but only if there is a loss of tissue below the lateral orbital rim.

To ensure proper distribution of the filler and to avoid any bumps and irregularities, the area of treatment is then gently massaged. Care is taken to inject away from any visible blood vessels in this area.

(Also read: Dermal Filler: Cannula Vs Needle)

The results from the tear trough treatment usually last up to 12-15 months, during which schedule follow-up sessions are advised to assess the clinical result.

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Complications in tear trough treatment using dermal fillers

Immediate complications that may arise from using HA fillers for tear trough include pain (which can be avoided by using lignocaine-based HA fillers as they are more comfortable), erythema, swelling, bruising, migraine, asymmetry etc. However, if the procedure is conducted incorrectly, then delayed complications such as infections, post inflammatory pigmentation, orange brown staining, the Tyndall effect, nodules and in extremely rare cases, blindness, may arise too. Hence it is crucial to undergo proper theoretical and clinical online international cosmetology training for dermal filler from a certified that as an aesthetic practitioner, he/she knows how to avoid and/or treat complications and risks that may arise.

About IIWAM training in dermal fillers

As always, the practitioner must undergo proper training in facial aesthetics to understand the procedure, the product, and the patient. Equally, he/she must know the benefits, risks, and counter-measures to correct complications. IIWAM also offers an Online Aesthetic Certification programme for Non-Surgical Body Sculpting, Advanced Dermal Filler Training (Restylane, Juvéderm, Teosyal, Bellotero), Advanced Botulinum Toxin Training (Botox, Dysport, Xeomin), Skin Booster Training (Restylane Skin Booster, Profhilo, Rejuran), Platelet Rich Plasma (PRP) Training, and Thread Lift Training (PDO, Aptos, Happy Lift).

At IIWAM, our trainers pay utmost attention to teaching the following subjects in administering dermal fillers for various treatments under Advanced Aesthetic Courses in Fillers.

  • Anatomy of the patient’s tear trough deformity

  • Methods & techniques for non-surgical tear trough treatment using HA fillers

  • How to inject fillers

  • Concentration and viscosity of the fillers

  • Various complications that may arise during the course of treatment

  • How to avoid those complications

  • How to treat those complications

About IIWAM Aesthetic Education

At IIWAM, we provide an International Aesthetic Certification program and also Advanced Online Aesthetic Courses for Doctors, Dentists, Nurses, Aestheticians, and Spa Owners in the field of Aesthetic Medicine.

Our Institute is based in Malaysia and has international students from the Philippines, Myanmar, Cambodia, India, Indonesia, and other parts of Asia. With our insignia of “Be Certified, Be Recognized”, we develop knowledgeable, skilled, and confident aesthetic practitioners of international repute. Our Aesthetic training focuses on teaching the principles of Aesthetic procedures before venturing into Aesthetic clinical skills. IIWAM training Programs are a combination of Onsite Training, LIVE Online Webinars, and Online Learning. IIWAM is the first Institute in the World to have its Programs assured by City & Guilds of London and certified by European International University. IIWAM is also a registered CPD Training provider with CPD Standards Office in the UK and by CPD Malaysian Medical Association.

Onboard is our Assoc. Prof Dr. Morthy, the lead trainer, medical director of the International Institute of Wellness & Aesthetic Medicine (IIWAM), formerly known as Aesthetic Academy Asia ( In the Aesthetic part of our Institute, we provide Advanced Aesthetic Medical Procedures that are Safe, Effective, and Affordable, offering a wide range of specialized treatments for All Your Aesthetic Needs.