Should I Get Tear Trough Fillers?

What are the main reasons people come in for tear trough fillers? And who makes a good candidate for the treatment?

The main reasons people come in - and these generally make the best candidates - are patients with hollowness under the eyes, prominent dark circles, the appearance of being tired or not well rested or flatness to the front of the face. Tear trough fillers work well with midface rejuvenation, so cheek filler, specifically. This is because, sometimes, there’s lack of volume in the midface, so adding a bit of filler can lift the tear trough and it can improve that whole area.

^{A before and after of tear trough filler treatment by Dr Ahmed.}

Who are tear trough fillers are not suitable for then?

I often get people come into the clinic asking for tear trough filler but, actually, that’s not the right treatment for them. With this treatment, the consultation process and patient selection is very important. Sometimes, people mix up hollowness and pigmentation because they go hand in hand. Tear trough fillers work well on hollowness but not on pigmentation. If someone doesn’t have hollowness and they get tear trough filler, it’s going to make the pigment look worse because it will make the area bulge. So when the light hits it, it’s going to look bad.

It’s very much a doctor-led treatment and the practitioner needs to do a really thorough consultation beforehand to make sure the patient is the right candidate. If someone gets the treatment done and they’re not the right patient for it, you can tell something is wrong with the under eye.

So what would you recommend instead for a patient with pigmentation in the under eye area?

For pigmentation, the best thing is medical grade skincare. See a doctor who deals in prescription-based skincare brands such as Obagi, pH Formula or Skinbetter Science. All these brands are formulated to deliver an intense dose of skincare from a scientific perspective rather than high street brands. So, using ingredients that will lift the pigment a little bit and hydrate the area is very important. But this needs to be done under the supervision of a medical professional.

What are some of the tear trough benefits clients experience?

It can be transformational to the way someone looks, lightening and brightening the under eye area. And it’s even more transformational to someone’s confidence. It’s really such a massive confidence boost. A lot of people really focus on their tear troughs and it makes them feel quite crappy about themselves, so that one little treatment can make a huge difference to them, their confidence and how they feel.

It only takes about 15 minutes and you see them walking out so much more confident. It gives them that boost that they needed. Especially for the ethnic communities - tear troughs are inherited in the Asian community and the Arabic communities, so finding a treatment that actually works is revolutionary for us. I’m sure that many people with tear trough issues have tried lots of eye creams - and none of them really work unless they’re prescription ones.

Click on the image to expand

^{Dr Ahmed from The Aesthetics Doctor, a tear trough filler extraordinaire!}

What should someone expect if they come to you for tear trough fillers?

A very, very thorough consultation and assessment of the under eye area. All makeup is taken off and we examine the area by looking at it from different angles - for example, the patient looking up, looking down, looking straight ahead. There is also a little pinch test, which is where I put my finger just under the crease of the eye and pull down to see if the dark circles reduce or not. That usually gives an indication as to whether it’s pigmentation or hollowness. If it’s pigment, it won’t change because the skin is pigmented in itself, whereas if it’s hollowness, it will.

Then, I advise the patient what will be the best course of action for them. With tear trough filler, the filler itself is very thin - almost water consistency. Filler is divided into different thickness - the thickest being basically bone-like, which is used for jawlines and chins and cheeks. Then, the thinnest ones are used for areas like the tear troughs because you want it to be very soft and delicate because the area is so thin. There are a variety of fillers out there, but one of my all time favourites is one by Teoxane, which is called Redensity 2. That one has a variety of ingredients, including vitamins, which should, in theory, help with any pigmentation as well, though it’s best for hollowness. The other filler I love for tear troughs is Volbella by Juvederm.

Can anyone inject tear trough filler?

The sad thing about tear trough fillers is that so many people think they can do them without the adequate training and understanding of anatomy. It’s actually a really advanced treatment for a reason. We use a cannula instead of a needle because there’s a theoretical risk of blindness with tear trough filler if you use a needle and you inject blindly under the eye. You could actually block a blood vessel. Whereas if you are using a cannula - the tip is blunt, so if it comes across a blood vessel it can go up above it or underneath it.

During lockdown, when clinics were closed a patient contacted me to say she had been to get tear trough filler treatment in someone’s kitchen. She knew it was the wrong thing to do but had been suffering with confidence issues and went ahead, but she felt like something wasn’t right. She sent me a photo and, actually, she was going blind. We had to open the clinic for her at 11pm to dissolve the filler, and we sent her to the hospital for antibiotics as well. The person who injected her actually blocked her on social media when she contacted them to say she thought something was wrong. The patient was just hours away from permanently losing her vision. Fortunately, she’s ok now but it took us around three weeks to get her back to normal because she needed to have the filler dissolved and then a couple of weeks of antibiotics and so on. You have to be really quick with things like vascular occlusions because you only have a matter of around 8-12 hours to fix it. Once the blood supply is blocked, that tissue starts to die. When I saw the photo, it scared the living crap out of me because I knew what it was. We need regulation that stops non medics from being allowed to inject.

Thanks so much, Dr Ahmed! That’s some brilliant advice for anyone thinking of getting tear trough fillers! If you think tear trough filler is the treatment for you, you can now search for a medically qualified practitioner in your area on Glowday.