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In this blog article, Dr Kieren Bong of Essence Medical Cosmetic Clinic in Glasgow is interviewed about the ins and outs of tear trough dermal filler.

What is a tear trough?

A tear trough is a deep groove between the lower eyelid and upper cheek. It can cast a shadow below your eyes, causing you to look tired. Some people think their tear troughs make them look older. As we age, the tissue in our face undergoes volume loss, gradually accentuating the severity of tear troughs.

What is tear trough filler?

A tear trough filler is an injectable treatment which uses a gel-like substance made of hyaluronic acid. The purpose of this procedure is to add volume beneath the tear trough. Hyaluronic acid is a substance which naturally exists in your body. When injected into the skin, this substance increases fullness and decreases indentations.

Who is a suitable candidate for this treatment?

You might be an ideal candidate for tear trough filler if you:

  • have mild to moderate sagging under the eyes
  • have healthy, thick skin
  • have realistic expectations
  • understand the treatment is temporary

You may not be a good candidate if:

  • your skin is very thin
  • you have excess skin beneath your eyes
  • your tear troughs are very deep
  • you have fat bulging under your eyes
  • you have an active skin infection in the area
  • you have a medical condition that increases your risk of complications

It would be best if you had a face-to-face consultation with a cosmetic doctor before having this treatment.

 We have heard this treatment can be dangerous. What can go wrong?

Tear trough filler injection is one of my most popular treatments, and I carry out this procedure multiple times per day at Essence Medical in Glasgow. I invented the Two Point Eye Lift™ technique several years ago. This technique is now used in over 50 countries and is widely recognised as one of the safest and most effective techniques for injecting tear trough filler. In addition, this technique is trademarked, and I am the registered trademark owner. In other words, I am the only person in Scotland who offers treatment for tear troughs using this technique.

When carried out in the hand of a skilled cosmetic doctor, this treatment is safe. 

What tends to go wrong is that the filler is placed too superficially, causing noticeable lumps. Likewise, too superficial a filler placement can cause blue discolouration in the treated area – a phenomenon called Tyndall Effect. I discussed this in detail in one of my blog articles (click here).

Many practitioners – especially those lacking the necessary skills and experience – use a sharp needle to inject the filler. I do not. Instead, I use a blunt instrument. Using a sharp needle in this area risks causing catastrophic complications such as blindness.

 How important is it that I have my treatment carried out by a reputable doctor?

Especially important. You want to go to a clever, skilled and experienced doctor. To have the necessary experience, the doctor should specialise in cosmetic medicine and work full-time in this profession. Above all, you want to go to someone you can trust with an excellent online and offline reputation.

What should I know about aftercare and results?

This treatment takes no longer than 20 minutes to complete, and you may return to work once the procedure is done. There is a risk of mild bruising and swelling – although, in my hand, these are uncommon.

The area under your eyes will look fuller, and you will look fresher, less tired and more youthful immediately. However, it can take 1-2 weeks to see the full results.

Be sure to follow our aftercare instructions, which typically include the following:

  • Avoid intense activity for 24 to 48 hours
  • Avoid sleeping face down.
  • Avoid massaging this area for 2 weeks

 What can someone do if they have had a botched tear trough filler treatment?

This can be straightforward or complex to deal with – it depends on what was botched. If there is a palpable lump, a simple massage may sort it, or a localised dissolving of the filler can be attempted. If the filler has been placed too superficially, then dissolving the filler is an option.

Oedema can happen with tear trough filler. This can be caused by an incorrect choice and too superficial a filler placement, causing water retention and puffiness in the treated area. This may need to be dissolved.

Why does so much go wrong with this treatment?

The anatomy in the under-eye area is complex, with delicate overlying tissues. Many of the side effects we commonly see associated with tear trough filler can be due to the following reasons:

  • Overconfidence of the injector
  • Wrong choice of filler
  • Wrong placement of filler
  • The injector lacks the necessary skills and experience
  • Too much filler has been injected
  • The patient wants too much after the tear trough has been adequately filled
  • The patient’s anatomy and physiology not being suitable

How long will some of these side effects last?

If left untreated, we have seen Tyndall Effect, excessive water retention and lumpiness in this area last over 3 years. In other words, a long time!

Find out more in our treatment page here.


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