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Previous lower eyelid blepharoplasty volume loss: Using the cannula for TearFill

Tear trough hollowing several years after lower eyelid blepharoplasty can be treated with tear trough and upper cheek to eyelid hyaluronic acid gel filler. There is a very good atraumatic way for the oculoplastic surgeon to treat this area with TearFIll.
I really like using a cannula for administration of filler into the cheeks and periorbital area. The reasons are that it is so much safer and much more accurate in order to get into deeper areas of the cheek without causing damage. In particular, I believe there is a lot less bruising and less swelling. The cannula is put through a single port in the upper outer cheek and from there I can reach up into the tear trough, down into the cheek and then back up the zygoma towards the temples. It gives me a wide area to treat, so I do not have to be constantly taking the cannula in and out, or if I were using a needle, I would have to be doing multiple injections. The fact that there is just one entry site also reduces bruising.
That entry site is made initially after a small amount of local anaesthetic has been given and then a sharp needle is used, which the patient does not feel, to make the skin hole in which I put the cannula. It is so small that as soon as the cannula has come out, it is virtually self-sealing within five to ten minutes.
By using a cannula, I can gently feel the tissues and work my way around obstructions deep within the cheek and the tear trough, with the patient feeling absolutely nothing other than my hands gently on the face and around the tear trough. Very occasionally, I came across an internal scar or ligament that I cannot get through easily with a cannula. As I do not want to press too hard, I would then do a little top up with direct needling technique.
The other big advantage of the cannula is, apart from reducing bruising, is that it cuts down the risk of inadvertently entering a blood vessel which could happen with a needle. If a blood vessel is entered around the eyes, there is always a risk of damage to the vision and of course we want to avoid that at all costs.
Periorbital tear trough filler should be administered by trained oculoplastic surgeons or other personnel who have been specifically trained in the use of fillers around the eyes. The treatment technique involves the patients semi-reclined with a light above them casting shadows across the face to accentuate the hollows. At the beginning of technique, the face is thoroughly cleaned with a sterile solution. Then with my gloves on I give the local anaesthetic, pass the cannula, do several passes internally to deliver the Hyaluronic acid gel. Once I am pleased with the result, I withdraw the cannula, and we gently clean the wound with saline and then that’s it. Sometimes the patient has to massage, sometimes they have to put ice on, but those are not the norm and usually, everything is just fine at the end. We do aim, not to over correct as it is much better to do it in small aliquots, gradually building up the right amount of filler. The fillers I use include Restylane and Juvederm.
Then, with my gloves on, I give the local anaesthetic, pass the cannula, and do several passes internally to deliver the Hyaluronic acid gel. Once I am pleased with the result, I withdraw the cannula, and we gently clean the wound with saline, and then that’s it. Sometimes the patient has to massage, sometimes they have to put ice on, but those are not the norm and usually, everything is just fine at the end. We do aim, not to over correct as it is much. It’s better to do it in small aliquots, gradually building up the right amount of filler. The fillers I use include Restylane and Juvederm.

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