Condition: Loss of facial volume (tear troughs)2019-04-05T16:03:13+00:00

Loss of facial volume (tear troughs)

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The best way to figure out whether your specific condition can be treated or not is to give us a call. We can answer any questions you have and help you clarify which treatment options might be suitable for you.

There are different treatment options available for this condition and the most common ones are listed below:

  • Fillers, aulologous fat and biostimulators

  • Hyaluronic acid gel

  • Sculptra (poly L lactic acid)

  • Autologous fat transfer

Learn more about treatment options

Loss of facial volume (tear troughs)

What is a Loss of facial volume (tear troughs)?

Facial and tear trough hollowing with age

With age there can be a loss of fat in the upper cheeks contributing to the cheek muscles and mid-face to sag. This results in hollowness below the eyes, giving a tired, aged appearance. When this affects the area between the lower lid and the cheek it is often referred to as a tear trough hollow or an orbito-malar groove. Tear trough hollows may present in patients who also have wrinkles,

Dermatochalasisageing skin etc. All of these conditions can be treated to improve the final result, using a combined approach of medical rejuvenation with filler (Restylane products), biostimulation (Sculptra) and  botulinum toxin A injection, skin care and oculoplastic (eyelid) surgery.

Video: What is Sculptra?

Examination for Loss of facial volume

First, the patient will be asked what aspect of their tear trough hollows and face concerns them. The whole of the face and periorbital area will be examined to determine if the hollows are best corrected by filler, surgery, or a combination of the two.

It is very common to take photographs from different angles and positions for comparison before and after an oculoplastic procedure. The oculoplastic surgeon may asks the patient to hold a mirror and point out the areas that most concern them. The patient should also bring along photographs of the face when younger as this helps in planning treatment.

The oculoplastic surgeon must be informed if there has been any prior filler treatment.

It is paramount to inform the surgeon of any known allergies.


Fillers, aulologous fat and biostimulators

The best treatment for tear troughs and cheek hollows is fillers. Usually hyaluronic acid gel is used but there are many different types. For more widespread hollow appearance around the eyes and cheeks or in non-cosmetic patients (i.e. post enucleation socket syndrome), we usually use fat – better known as an autologous fat transfer (also known as a Coleman fat transfer). We also use Sculptra (poly L lactic acid) a biostimulator of deep collagen which gives a very natural look in the over 45 years old group.

Hyaluronic acid gel

Hyaluronic acid is produced naturally by the body and found in soft tissues. The Restylane®, Juvederm® and Teosyal® ranges are synthesised and commonly used cross-linked hyaluronic acid gels. These are chemically similar to the naturally occurring gel and are inert and hypoallergenic. There are many other named brands.

Hyaluronic acid gel causes few side effects and complications. It is therefore regarded as one of the safest fillers for use in tear troughs and for loss of periorbital facial volume.

Hyaluronic acid gel is injected in clinic during a routine visit and causes very little swelling and only occasional bruising. Most people feel happy to return to work immediately.

Treatment with hyaluronic acid gel is entirely reversible, either over time or with an injection of hyaluronidase to degrade it. The injection of this enzyme is used by the physician “off-label” as it is not licensed for the use or reversing hyaluronic acid. That means that there have been no safety and efficacy studies.

Sculptra (poly L lactic acid)

Sculptra has a long and proven track record as a biostimulator of the patients own deep facial collagen and gives a very natural look, lasts two to three years and has a low rate of complications. It is injected via a fine canula through a very small number of tiny skin entry points through which most of the face can be reached. It was pioneered in HIV patients over 25 years ago in order to correct the facial atrophy (lipodystrophy) and its use has now been extended to the aesthetic rejuvenation of the face. At Clinica London it is used in patients over 45 years of age usually, who want a very natural healthy facial volumisation.

Autologous fat transfer

The autologous fat transfer is a technique in which the filler used is fat from the patient’s own body. Hence, this is a completely natural substance that gives good results and should be injected deep in the cheek and periorbital area. Great care is taken no to go too close to the eyelids so as to avoid visible or palpable bumps. It is a more invasive procedure than hyaluronic acid gel filler and recovery time is longer. The effects of an autologous fat transfer are more permanent than hyaluronic gel fillers – a percentage is reabsored during the first months following injection and what then remains can last for many years. Fat is taken from the stomach or thigh using a liposuction technique. This fat is then prepared and injected into the lower eyelids, cheek, face or sub-brows. This is usually done in theatre under general anaesthetic.


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Frequently Asked Questions

The hyaluronic acid gel (Restylane® or Restylane Perlane®) is injected in clinic during a routine visit. The filler injection is done slowly with a small needle. At Clinica London we often inject fillers in different areas around the eyes and cheeks in small volume staged injections, 2-4 weeks apart.

This minimises bruising, allowing the patient to go back to work immediately, and also minimises the risk of overfill.
The autologous fat transfer is done by taking some fat from the stomach or thigh of the patient using a liposuction technique. This fat is then prepared and injected into the lower eyelids, cheek, face or sub-brows. This is usually done in theatre under general anaesthetic.

Most patients say that they feel little or no pain during the injections, especially as the manufacturers now combine the filler with local anaesthesia.

If you think you are more sensitive to pain you can have painkillers and tranquilising tablets before coming to the clinic and anaesthetic cream can be applied to the skin.

The procedure is usually done under general anaesthetic. Afterwards, the harvest site and the face may be a little bruised and swollen with a alight ache for a few days, but you should not feel particularly uncomfortable.

You may want to use ice packs if there is a little bruising or your usual painkillers if you feel discomfort.

After hyaluronic acid gel filler injections general advice is simply to gently manage and mould the area injected during the first 24 hours. Your oculoplastic surgeon will advise you how to do so.

HAG: It depends on the nature of your work but as pronounced bruising and swelling is unlikely, the majority of patients go straight back to work.
Autologous fat transfer: Yes. It is advisable to rest for 7-10 days at home.

As with any procedure there is a small risk of complication. Serious complications such as infection, bleeding or loss of vision are extremely rare but have been reported both for hyaluronic acid gel fillers and autologous fat transfer.

The most common complication is some bruising in the injected area that often settles after a few days. We will aim to achieve perfect symmetry but sometimes this is not possible. Occasionally more than one procedure needed to achieve the best result, for instance combination with blepharoplasty surgery and botulinum toxin.
If the asymmetry is very obvious or the appearance of the filler is very bumpy, sometimes it is necessary to remove it. Hyaluronic acid gel is removed with an injection of hyaluronidase enzyme into the same area. Autologous fat is removed surgically.