Tuesday, May 17, 2022

Candidates, Results, Side Effects, Cost and More

  • Tear trough fillers add volume beneath the eyes to reduce the appearance of fine lines, puffy eyes and dark circles, and restores a youthful appearance
  • Hyaluronic acid fillers are the most popular, are generally safe, and provide immediate results that typically last between 6 months to 1 year
  • Under-eye fillers are priced by the syringe with total costs ranging from $700–$2,500 per treatment

With age, skin produces less collagen and elastin, the proteins responsible for skin’s structure, elasticity and firmness. This causes the skin to become thinner and looser, and these changes manifest in the eye area as fine lines, puffy lower eyelids and dark under-eye circles. Tear trough fillers are an effective treatment strategy for these concerns.

What Are Tear Trough Fillers?

Tear trough fillers (also known as under-eye fillers) are essentially off-label dermal fillers. They are being used in a different manner than originally intended, which is the treatment of wrinkles and textural acne scars, and as well as augmentation of the cheeks, lips, chin and hands. 

Recently, the FDA approved Juvederm Volbella XC for under-eye use. While other fillers are not FDA-approved for this purpose, they are marketed as such, and can be safely used for this purpose when administered by a skilled practitioner. 

These fillers are injected just below the eye to add volume to the immediate area which smooths fine lines, evens out hollow areas and disguises puffiness that occurs with weakened skin tissue. They can also effectively reduce the visibility of dark under-eye circles that are caused by visible subcutaneous blood vessels that become noticeable under thinning skin.

Under-eye fillers can provide all these benefits with no downtime, are well tolerated and offer immediate results.

Types of tear trough fillers

There are a wide range of  temporary and semipermanent tear trough fillers available to choose from. They perform differently once injected as they differ in viscosity, firmness and dispersion. Your provider will choose the best one based on your specific needs and goals.  

Hyaluronic acid fillers are the most common temporary fillers. This substance is found naturally within the body and plays an important role in skin health by supporting collagen production, and attracting and retaining moisture to skin. 

As well, these fillers are associated with the least amount of side effects since it is naturally found within the body. Over time, the filler is absorbed into surrounding tissues.

Hyaluronic acid fillers have been demonstrated to effectively reshape the under-eye area, providing esthetically pleasing, long-lasting results with minimal side effects. Popular choices include Restylane, Belotero and FDA-approved Juvéderm Volbella XC.

Semipermanent fillers include Bellafill, Radiesse and Sculptra; each is made from a different material:

  • Bellafill consists of a combination of bovine collagen and polymethyl methacrylate (PMMA) spheres. The collagen solution provides an initial volume boost, while the PMMA spheres provide a supportive structure that stimulates natural collagen production as it gradually replaces the collagen gel
  • Radiesse is a calcium hydroxylapatite gel filler that is very effective for the under-eye area; it prompts collagen production, adds volume to smooth the skin’s surface and eliminates shadows and dark circles
  • Sculptra is made from poly-L-lactic acid, a known collagen stimulator; it improves the thickness of skin and can provide natural-looking, long-lasting results 

Many under-eye fillers—temporary and semipermanent—contain lidocaine, an anesthetic that helps ease discomfort.

A tear trough filler procedure can also be performed with fat grafting. Your provider will extract fat from a part of your body— typically your thighs—process it and reinject it into your under-eye tissue. Since it uses your own fat, this procedure has little risk of triggering an allergic reaction, and provides a natural look and feel. Results usually last about 3 years.

What to Expect During the Procedure

An under-eye filler procedure is typically a quick process. You’ll be asked to arrive at your appointment makeup-free. Your provider will cleanse your skin with a medical-grade cleanser, and apply a topical numbing cream for your comfort. You will sit up throughout the process. 

They will then inject the filler using a needle or a cannula – a small, thin tube that is inserted under your skin. Your provider will slowly inject small amounts of filler to targeted areas until the desired result is achieved. This slow pace will help minimize swelling. 

Many providers will mold the filler with their fingers immediately after it’s injected to ensure it is shaped correctly. 

The injection process typically lasts about 15 minutes, after which your provider will apply ice to the area to reduce bruising or swelling. You can expect the procedure to be complete within 45 minutes to 1 hour.

Recovery and aftercare

It’s common to experience some soreness, swelling and bruising immediately following the injection of tear trough fillers; this should resolve within 2 days. Some bruising may last up to 1  week.

Immediately following your procedure, avoid touching the area for at least 24 hours. Don’t use any makeup or skin care products until the following day to prevent potential infections. Aim to ice the area in ten-minute sessions every few hours for the first day. 

Avoid strenuous exercise for 48 hours afterward to avoid heavy bruising and to prevent the filler from moving.

Results

Tear trough fillers can address lost volume beneath the eyes to smooth the appearance of fine lines and puffy lower eyelids, and reduce the appearance of dark circles. They can help support healthy skin by stimulating collagen production. In this manner, they can help restore a youthful appearance.

In one study examining the efficacy of under-eye treatments, researchers found a profound improvement could be achieved with hyaluronic acid fillers. Another study reported a 100% satisfaction rate of all participants after several requested and had follow-up touch ups. 

The results of tear trough filler injections will vary from one person to another, depending on their unique condition and the type of filler used.

When are results visible?

Results are visible immediately following the procedure, although some swelling may make it difficult to discern; it is recommended to wait 1 week to see your final results.

How long do tear trough fillers last?

Temporary fillers eventually break down and are absorbed by the body. They last between 6 months to 1 year; semi-permanent fillers are made with more viscous substances and can last 12–18 months before dissolving naturally.

Most hyaluronic acid-based tear trough fillers last between 6 months to 1 year for the average person, but may last longer for some depending on the individual. 

Side Effects and Complications

The most common side effects of tear trough fillers are swelling, bruising and some soreness or discomfort following the procedure. These are all temporary side effects and they should resolve within a few days. 

It’s possible for under-eye fillers to yield unsatisfactory results. You may not like your results or your eyes may appear puffy, asymmetrical or uneven in texture.  In some cases, infection can occur. 

For hyaluronic-based fillers, your provider can take corrective action by:

  • Messaging the under-eye area to more rapidly absorb the filler
  • Injecting the enzyme hyaluronidase to dissolve the filler

For non-hyaluronic-based fillers:

  • Injecting the surrounding tissue to even out the look of the skin  
  • Surgical removal of the filler

Other risks

There are other risks associated with under-eye fillers that are rare but should be considered when opting for this treatment:

  • Postprocedure infection, which can require antibiotics and may develop up to 6 months after a procedure 
  • Sensitivity reactions, which may also develop long after the procedure; symptoms include redness, swelling and soreness 
  • Increased appearance of hyperpigmentation
  • Vascular risks caused by an accidental injection of filler into an artery which can cause occlusions; this is considered a serious event
  • Puncture of a blood vessel, which can cause an ocular occlusion, resulting in partial or full blindness 

Cost of Tear Trough Fillers

The cost of tear trough fillers varies widely depending on a number of different factors including your location, your provider’s fees, the type of filler used and the number of syringes required. Most procedures require multiple syringes.

To maintain results, you will need to schedule visits at regular intervals. Your provider may offer a reduced rate if you commit to a certain number of treatments.

  • Bellafill: $1,060
  • Fat transfer: $2,500
  • Hyaluronic acid: $685
  • Radiesse: $700
  • Sculptra: $850

How to pick a provider

For the best outcome, choose an experienced board-certified dermatologist or plastic surgeon. Opt for a qualified professional as they will know which filler is best for your needs and will apply the correct technique. This will also reduce your risk of complications. 

Alternatives

Tear trough fillers may not be the treatment of choice for everyone but fortunately, there are alternative treatments available.

Over-the-counter creams 

There are several over-the-counter (OTC) anti-aging creams that contain high concentrations of hyaluronic serum, which can plump up and smooth skin over time. While they won’t produce the same results as fillers, they cost far less and do not have any associated risks.

Other OTC creams that contain antioxidants, retinoids and peptides (including collagen peptides) can also plump the skin in the tear trough area to help reduce the appearance of hollows or dark circles. 

Skin tightening or eye lift surgery

Two other professional treatments have been shown to dramatically improve the under-eye area, however they are more invasive. 

Laser skin resurfacing using the ablative CO2 or Erbium laser creates microinjuries to skin which prompts increased collagen production to soften lines and wrinkles, and tighten sagging skin. 

Eyelid surgery is an invasive treatment and as such, involves downtime. In this procedure, your surgeon will remove excess skin from below your eyes, perform a fat transfer to restore fullness or use a combination of both. Surgical procedures carry more risks and cost more but provide dramatic long-lasting results. 

Takeaway

Tear trough fillers are a quick and effective solution to reduce the appearance of fine lines, puffiness and dark circles in the eye area to restore a youthful appearance. 

Fillers made with hyaluronic acid are temporary and last up to 1 year; semipermanent options can last 12–18 months. Your provider will choose the most appropriate filler for your specific needs. To maintain your results, you will need repeat treatments. 

For best results, and to avoid unnecessary risks, choose a board-certified professional with expertise in administering under-eye injections.

Sources

  • US Food & Drug Administration. JUVÉDERM® VOLBELLA® XC – P110033 / S053. Available at:
    https://www.fda.gov/medical-devices/recently-approved-devices/juvedermr-volbellar-xc-p110033-s053
  • Sharad J. Dermal Fillers for the Treatment of Tear Trough Deformity: A Review of Anatomy, Treatment Techniques, and their Outcomes. J Cutan Aesthet Surg. 2012;5(4):229-238. doi:10.4103/0974-2077.104910
  • Vrcek I, Ozgur O, Nakra T. Infraorbital Dark Circles: A Review of the Pathogenesis, Evaluation and Treatment. J Cutan Aesthet Surg. 2016;9(2):65-72. doi:10.4103/0974-2077.184046
  • Murthy R, Roos JCP, Goldberg RA. Periocular hyaluronic acid fillers: applications, implications, complications. Curr Opin Ophthalmol. 2019 Sep;30(5):395-400. doi:10.1097/ICU.0000000000000595
  • Shetty R. Under eye infraorbital injection technique: the best value in facial rejuvenation. J Cosmet Dermatol. 2014 Mar;13(1):79-84. doi:10.1111/jocd.12075
  • Joseph JH, Eaton LL, Cohen SR. Current Concepts in the Use of Bellafill. Plast Reconstr Surg. 2015 Nov;136(5 Suppl):171S-179S. doi:10.1097/PRS.0000000000001839
  • Haneke E. Polymethyl methacrylate microspheres in collagen. Seminars in Cutaneous Medicine and Surgery. 2004 Dec;23(4):227-232. doi:10.1016/j.sder.2004.08.002
  • Loghem JV, Yutskovskaya YA, Philip Werschler W. Calcium hydroxylapatite: over a decade of clinical experience. J Clin Aesthet Dermatol. 2015;8(1):38-49. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4295857/ 
  • Breithaupt A, Fitzgerald R. Collagen Stimulators: Poly-L-Lactic Acid and Calcium Hydroxyl Apatite. Facial Plast Surg Clin North Am. 2015 Nov;23(4):459-69. doi:10.1016/j.fsc.2015.07.007
  • Vrcek I, Ozgur O, Nakra T. Infraorbital Dark Circles: A Review of the Pathogenesis, Evaluation and Treatment. J Cutan Aesthet Surg. 2016;9(2):65-72. doi:10.4103/0974-2077.184046
  • Diwan Z, Trikha S, Etemad-Shahidi S, Alli Z, Rennie C, Penny A. A Prospective Study on Safety, Complications and Satisfaction Analysis for Tear Trough Rejuvenation Using Hyaluronic Acid Dermal Fillers. Plast Reconstr Surg Glob Open. 2020;8(4):e2753. Published 2020 Apr 29. doi:10.1097/GOX.0000000000002753
  • Edwards PC, Fantasia JE. Review of long-term adverse effects associated with the use of chemically-modified animal and nonanimal source hyaluronic acid dermal fillers. Clin Interv Aging. 2007;2(4):509-519. doi:10.2147/cia.s382

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