One of the most noticeable problems in the fight against aging is the correction of the tear (nasolacrimal) groove. The presence of this groove ages and tires the appearance of the face.
Tear trough forms as a result of the impact of gravitation on the aging process, which leads to the formation of infra-orbital fat herniation.
The main structural feature of this area is the presence of a septum which is a membranous sheet that connects the skin with the periorbital muscles. The septum is attached to the bones, which allows for a minor movement in the upper third of the face than in the middle and lower thirds. However, the sagging of the soft tissue still occurs because of the stretching and weakening of the ligaments of the septum, which lengthen, but remain bound to the bone and skin; visually this area shows depressions or hollows. Local lipodystrophy makes these imperfections more profound. Lumps are formed in the mobile areas where there is a minimal fixation of the ligaments to the skin. The changes of the relevant bone structures and the atrophy of the dermal fat layer also contribute to the aging of the face.
Relaxing of soft tissue that begins from the inner corner of the eye and descends laterally has many names: tear trough, palpebra malar groove, nasojugal groove, nasolacrimal groove. In my opinion, it is important to highlight the tear trough and buccal space groove. Tear trough is the deepest medial part of the skin imperfection, located below the edge of the bone of the orbit. The buccal space groove is an external lateral extension in the zygomatic (jaw) region. When doing a correction with injections it is very important to distinguish between the two areas, since the tear trough requires the use of less dense filler, whereas the buccal space is filled using denser, thicker filler. And consequently, the technique of injection will also be different.
There are only a few ways to correct the tear trough. There is lipofilling which is the injection of hyaluronic acid, and there is blepharoplasty, which is a surgical procedure in which the lumps of fat are moved. The surgical option removes the nasolacrimal groove for a long time; however, there is always a risk of contouring these fat pockets, which significantly aggravates the cosmetic side of this procedure. According to Western literature, lipofilling gives a prolonged result, but in my experience, the longevity of the result after this method is not better than after the injection of a hyaluronic acid based implant.
The method of correction of the tear trough using hyaluronic acid became more implemented only in recent years. This is due to the appearance of less dense fillers, and due to the development and improvement of injection techniques. Modern, hyaluronic acid based fillers have one more significant advantage, which is the option of adding anesthetics to the existing components, which makes the procedure less painful and significantly more comfortable. This is why these fillers are becoming more popular, and not only with patients but with doctors. For practitioners, it is more convenient knowing that their client is not experiencing any pain. In terms of popularity of this procedure, now it can be compared to correction of nasolabial folds using fillers.
Injections of hyaluronic acid are safe, and can easily be removed when requested. There is a small risk associated with injections due to a small amount of soft tissue, a proximity of vital anatomical structures (neurovascular bundles) in the periorbital area. However, Injections of hyaluronic acid are safe, and can easily be removed when requested. The most important thing for a practitioner is the correct selection of the density of the filler, appropriate volume and being able to implement the correct depth of the injection.
