The Secret Byron Bay

The facts about infraorbital hollows and Dermal Fillers (Tear trough)

March 03, 2024

Tear troughs deficit has been a regular presentation of patients booking into Aesthetic clinics. It’s not so long ago that this was a common dermal filler treatment with some practitioners using large volumes in this area. Gradually, safety concerns began to be raised, with the classification of a high risk area for vascular occlusion beginning to be discussed. But then, along came the cannula and suddenly it was said to be safe again!

Having worked in the field of Aesthetics for the past 13 years (prior to this 25 years as an Emergency Nurse Practitioner in the National Health Service, UK), this had always been a contentious area for me. Having dealt with multiple cases of Infraorbital lacerations over the years caused by injury and trauma. Seeing and having to explore the anatomy which lay beneath that incredibly delicate skin first hand, I knew this was not only a very unforgiving area but one that needed to be treated with the utmost of caution!

Back in my aesthetic clinic years later, faced with my patient, concerned with their under eye hollow, I knew this was not a place to freely fill! I had been to many conferences, training and mentoring sessions over the years and still I was astounded by this ‘Just fill it’ approach.

I had no clinical evidence or research data to help me with my humble ramblings to my patients, who just wanted that quick fix dermal filler treatment that they had seen posted on social media forums. As the time went by, I started seeing patients asking for help with their ‘tear troughs’, this time not because they wanted them filled but because of the ‘sausage’ like pillows and lumps in the very area that they already disliked!

Time and time again these poor patients just kept arriving. You see, I have never been averse to saying ‘no’ and suggesting other alternatives. Although this approach may have cause them to go elsewhere, they were coming back because now they trusted my opinions and cautions, alas to their detriment!

I then stumbled across a video on Social media a few years ago, I could not have hoped for anything better than an honest and open discussion at last! Using MRI scans as a tool to actually pin point where dermal filler can migrate to and its longevity, although quite shocking, was what I had sadly suspected. However, I now had reliable evidence to explain the facts to my patients instead of my ramblings of ‘it might’ and ‘its possible that it could end up in the globe’ and ‘no-one really knows how long it will last’ etc.

I will leave you to watch Dr. Gavin Chan refreshingly, talking about his experiences and his research findings, explaining why he stopped performing this treatment after 14 years of filling tear troughs with dermal fillers.


How do you treat the Infraorbital hollows?

Assessment is key as the skin quality and thickness is so important, if the cause is due to dark pigmentation and not indentation then dermal fillers will not make any difference. For some patients a dermal filler to the mid cheek can change the appearance of the hollow.


Skin health is key

I have found that using a combination of Skin-needling and Peri-orbital prescription Mesotherapy can really help skin texture and health. Gentle stretching of Orbicularis Retaining Ligament with a needle can also help lift and stretch the ligament thus releasing it slightly. It’s this ligament that when filler is placed in the superficial plane can causes the ‘sausage’ affect, as the filler is unable to diffuse due to the ligament being in the way, causing the filler to bulge and in some cases making the hollowing worse.

The latest study published in August this year revealed that the “Toxin Lift” injection technique is capable to improve the clinical appearance of infraorbital hollows. The effects can be explained by the concepts of facial biomechanics. This was achieved using four superficial injection along the jaw line using anti-wrinkle solution. I have long believed that the treatment of the lower face with anti-wrinkle injections has a chain reaction in the mid face, enhancing the overall affect.

A lower blepharoplasty can also be performed by an ocular plastic surgeon or plastic surgeon to remove excess skin and fat from the under eyes area and the retaining ligament can be surgically released.

Safety and efficacy should always be at the forefront of all treatments. We should never down play the risks and we should explore all possible outcome.


Peri-orbital Mesotherapy @thesecretbyronbay_

Using the latest prescription mesotherapy specifically formulated for the peri-orbital region containing Free HA (hyaluronic acid), 12 vitamins + 24 amino acids + 6 co-enzymes + nucleic acid + 6 minerals is superficially micro-injected, using a 0.6mm needle depth to infuse micro droplets. Can treat the most delicate of areas of skin surrounding the eye where most other treatments cannot go!
3 sessions spaced out by 15 days + 2 sessions spaced out by 1 month. This treatment may cause swelling and possible bruising. Cost – $295 per session.

Serving Byron Bay, Ewingsdale, Myocum, Ocean Shores, Alstonville, Ballina, Lennox Head, Brunswick Heads, Pottsville, Murwillumbah, Cabarita Beach, Casuarina, Kingscliffe, Tweed Heads, Terranora, Gold Coast.

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