Correction of Tear Trough Deformity With a Cohesive Polydensified Matrix Hyaluronic Acid

Abstract

The tear trough or infraorbital hollow is a challenging area to treat, and only a few fillers are suitable for this delicate area. We report on a European case series of six subjects with mild to severe tear troughs who received treatment with cohesive polydensified matrix (CPM®) technology hyaluronic acid gel (Belotero® Balance). The product was injected as small depots (up to ten small boli 0.2 mL maximum each per side) at the supraperiosteal level along or below the orbital rim. Follow-up visits took place at 1, 3, 6, and 9 months after injection for independent evaluation of the clinical effect using the Merz Aesthetics Scale™ for infraorbital hollows and the Global Aesthetic Improvement Scale. Adverse events were also recorded. Mean hollowness scores were considerably improved compared with baseline in all subjects. In all women, the improvements remained throughout the 9-month study, with none reverting to their baseline score. Subjects' satisfaction with treatment was very high throughout the study, and all women stated that they would repeat treatment with the same product. The CPM hyaluronic acid gel was well tolerated. CPM hyaluronic acid gel is a safe and effective treatment for the tear trough area.

Tear Trough Filler Techniques Utilizing Hyaluronic Acid: A Systematic Review

“…Out of the 16,302,063 articles identified from the database search, 32 were included in the systematic review; 20 utilized only hypodermic needles (needle-based), 46–65 and 12 utilized only blunt-tip cannulas (cannula-based). 24,27,33–36,66–71 One study met inclusion criteria but was ultimately excluded from the analysis as the injection method of delivery was not systemized.…”

“…Out of the 16,302,063 articles identified from the database search, 32 were included in the [46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65] and 12 utilized only blunt-tip cannulas (cannula-based). 24,27,[33][34][35][36][66][67][68][69][70][71] One study met inclusion criteria but was ultimately excluded from the analysis as the injection method of delivery was not systemized.…”

“…Multiple articles blinded reviewers prior to photographic assessment. 53,55,70 Fifty-five percent of needle-based articles and 20 percent of cannula-based articles applied at least one of the following scales: Likert-type Scale, 53 Infraorbital Hollowness Score, 47 visual analogue scale, 70 Global Aesthetic Improvement Scale, 24,47,48,55,56,70 Hirmand Classification System, 64 Allegran Infraorbital Scale, 48 and Barton Grading System. 71 Though articles using these scales reported significant improvements in aesthetic and patient outcomes, the subjective nature of photonumeric scales led to highly variable results and made it difficult to assess for grading consistency.…”

Validated 5‐point photonumeric scales for the assessment of the periorbital region

“…1 Visible signs of aging in the periorbital region include the appearance of aggravated lateral canthal lines at rest (ie, static crow's feet) and upon smiling (ie, dynamic crow's feet) and infraorbital hollowing. [2][3][4][5][6][7] The pathophysiology of crow's feet has not been explained in full detail; however, the repeated activation of the orbicularis oculi muscle and its dense connection to the dermis by so called retinaculae cutis together with increasing skin laxity is considered as the main reasons for their appearance.…”

“…5,8,9 A plethora of minimally invasive and surgical treatments can be chosen to ameliorate static and dynamic crow's feet as well as infraorbital hollows. 2,3,10,11 The use of neurotoxins to relax the orbicularis oculi muscle and intradermal injection of hyaluronic acid bases soft tissue fillers have been shown to reduce the severity of crow's feet efficiently and with high satisfaction for the patient, while possessing an acceptable safety profile and relatively little side effects. For infraorbital hollows, injections with low-viscosity hyaluronic acid-based soft tissue fillers have been shown to create a rejuvenated look by replenishing lost volume.…”