Injection of commercial fillers into tear troughs has been one of the most unfortunate trends in recent cosmetic medical practice. The treatment often delivers an incomplete or failed aesthetic result and is frequently associated with long term swelling , lumpiness, bruising and a bluish skin discolouration known as Tyndall effect.
This filler treatment fails on the basis of a misappreciation of the ageing anatomy in this facial region that has been educationally promulgated by most of the filler companies via their medical advisers. This has resulted in an entire battalion of misguided injectors (including myself initially) out there causing grief to patients with poor aesthetic outcomes.
The anatomy of tear trough (nasojugal groove) ageing need to be understood. It is is a normal anatomical depression that runs from the inner aspect of the eye (near the nose) diagonally outwards down the cheek. The tear trough deepens with ageing due to the cheek (malar) fat pad below reducing in volume and also sagging downwards (ptosis). Another fat pad located under the circular muscles around the eye (oribularis oculi) called SOOF also reduces and sags with ageing.
Essentially the popular rationale that promotes treating the tear trough by injecting fillers under the orbicularis muscle may somewhat augment the diminished the targeted SOOF fat pad. However such an approach is usually aesthetically insufficient as it is the whole cheek (malar) complex that requires augmentation by much more volumising and durable fillers. The outcome in the hands of skilled injectors results in a projected and somewhat elevated the cheek that is in aesthetic harmony with the eye (orbital) complex above it.