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Are you tired of looking tired all the time?

Tear trough hollows and dark circles, making you look tired even though you have had enough sleep are one of the commonest reasons young adults, male and female, come to Clinica London for TearFill ® treatment with Restylane and Lidocaine. In this blog post, I describe my cautious approach to filling this delicate under eye area with Restylane TearFill ®.
If there is a deep tear trough hollow running in the under eye area from the corner of the eye (medial canthus) down under the eye to the mid-papillary line; and, even further round towards the lateral canthus giving quite an appearance of a lot of hollowness, I may have to do more than one treatment with TearFill ®.
Traditionally, I am very cautious with TearFill ® treatment as I want my tear trough patients to look naturally filled and not overfilled. The periorbital area is extremely delicate and has to be rejuvenated in a very thoughtful and precise way. The amount required by each patient is very particular, depending on the size of their face, the amount of hollowing, the amount of cheekbone projection and the amount of soft tissue.
The tear trough hollows worsen as people get older and therefore the older patient will likely require a larger volume than the younger patient. Filling the tear trough or TearFill ® is a specialised technique which requires oculoplastic training and hence a good knowledge of the under eye area, the anterior cheek, the upper lateral cheek and particularly the specific fat pads of the face and orbital eye anatomy.

How I can make you look less tired

I have first to assess the patient. I look to see where there is a lack of volume, whether, in the anterior cheek over the cheekbones, the upper outer cheek over the area called the zygoma if there is lack of soft tissue volume.
Then I can decide the distribution of the volume loss or descent that has to be replaced and built up using cannula treatment. I aim to give an aesthetically pleasing periorbital appearance remembering that the tear trough area is in continuity with the cheek and forms part of the periorbital conjunct.
I have to provide proper support in the upper cheek before placing the filler in the tear troughs.
I always warn patients of possible complications of injection of fillers, and they must all have signed consent before any filler treatment, not just in the periorbital area.
The immediate complications can be a small bruise and swelling and tenderness.
There is always a small risk of intravascular injection and vascular occlusion, which has to be dealt with using high dose hyaluronidase. Fortunately in the under eye tear trough area vascular occlusion is extremely rare, particularly with the use of cannula for injections.
Whoever you choose to do your tear trough hollows with filler, you need to make sure that they know how to deal with the potential complications and that they have the necessary resources with which to treat with hyaluronidase should that be required.
As an oculoplastic surgeon trained in eyelid surgery over the last twenty years and have been doing tear trough filler for ten years. I have developed my distinctive approach to the tear troughs called TearFill ®, carefully observing the shape and volume, the patient’s fundamental need and delicately building up the tear trough with hyaluronate gel Restylane and Lidocaine, all through a single entry port each side and very fine cannula.
I aim to make your tear troughs look less hollow, reduce dark circles under the eyes, and make you look naturally less tired.


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