Dermal Fillers for Tear Trough Rejuvenation: A Systematic Review

Abstract

There is significant variation in treatment parameters when treating the infraorbital region. Thorough knowledge of these pertinent factors, choice of the optimal filling material, and proper understanding of the anatomy of this unforgiving region will contribute to a safe, effective, and natural result. We aim to conduct a systematic review of published literature related to soft tissue fillers of the tear trough and infraorbital region. A search of published literature was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and included PubMed, Embase, and Science Direct databases. The Medical Subject Headings (MeSH) terms used were “tear trough” OR “infraorbital” AND “dermal filler” OR “hyaluronic acid” OR “poly-L-lactic acid” OR “calcium hydroxyapatite” OR “Restylane” OR “Radiesse” OR “Perlane” OR “Juvéderm” OR “Belotero.” Different combinations of these key terms were used. The initial search identified 526 articles. Six additional articles were identified through references. Two-hundred twenty-five duplicates were removed. A total of 307 studies were screened by title and abstract and 258 studies were eliminated based on inclusion and exclusion criteria. Forty-nine articles underwent full-text review. The final analysis included 23 articles. Patient satisfaction was high, and duration of effect ranged from 8 to 12 months. Restylane was most commonly used. Injection technique varied, but generally involved placing filler pre-periosteally, deep to orbicularis oculi muscle, anterior to the inferior orbital rim via serial puncture or retrograde linear threading with a 30-gauge needle. Topical anesthetic was most commonly used. Side effects were generally mild and included bruising, edema, blue–gray dyschromia, and contour irregularities. Nonsurgical correction of the tear trough deformity with soft tissue filler is a minimally invasive procedure with excellent patient satisfaction with long-lasting effects. It is essential to have a fundamental understanding of the relevant anatomy and ideal injection technique to provide excellent patient outcomes and prevent serious complications.

Laser‐assisted blepharoplasty: An innovative safe and effective technique

“…The blepharoplasty, which treats not only the superficial skin tissue but also the connective and the muscle tissues, is defined as a medical act capable of inducing a localized alteration or transportation of live human tissues. Although Spada and Trinh et al 24,32 have been proposed, these procedures cannot be compared to a surgical procedure. The addition of CO 2 laser-assisted blepharoplasty to upper and lower blepharoplasty has proven to be a safe and efficient procedure.…”

Belotero: What we know now

“…A 2014 prospective study of 46 patients with tear trough deformity treated with Belotero Balance found that mean hollowness scores were significantly improved for both eyes at 2‐, 6‐, and 10‐ weeks compared to baseline. No complications were reported within the 10‐month follow‐up period 15 …”

“…No complications were reported within the 10-month follow-up period. 15 Overall, Belotero Balance has been found to be particularly useful for fine lines. 1 This includes forehead lines and the glabella ("11's"), for which a filler with low to moderate G′ is appropriate following treatment with a neuromodulator.…”

Algeness—What do we know about this filler

“…AG fillers are nonhydrophilic and therefore do not attract water to the site of deposition, reducing the algesia found in hydrophilic HA products associated with additional volume expansion 14 . This is especially important when treating areas, such as the tear troughs, where the overlying skin is thinner and excess edema can lead to visual contour irregularities 15 . However, its true cosmetic value lies in its method of bodily elimination in that, unlike other fillers, no human enzyme readily degrades it 3 .…”

“…14 This is especially important when treating areas, such as the tear troughs, where the overlying skin is thinner and excess edema can lead to visual contour irregularities. 15 However, its true cosmetic value lies in its method of bodily elimination in that, unlike other fillers, no human enzyme readily degrades it. 3 Instead, agarose is metabolized by the macrophages and transported to the reticuloendothelial system where it hydrolyzed to monomers by intracellular galactosidases.…”