Expert Recommendations on the Use of Hyaluronic Acid Filler for Tear Trough Rejuvenation

April 2022 | Volume 21 | Issue 4 | Original Article | 387 | Copyright © April 2022


Published online March 31, 2022

Andreas Nikolis MD PhD,a Cameron Chesnut MD,b Brian S. Biesman MD,c Mohammed A. Alsufyani MD,d Charles Boyd MD,e Wendy W. Lee MD,f Robert Schwarcz MD,g Philippe Berros MD,h Bill Andriopoulos PhD,i Kay Durairaj MDj

aMcGill University Health Centre, Montreal, QC, Canada
bUniversity of Washington School of Medicine, Spokane, WA
cVanderbilt University Medical Center, Nashville, TN
dPrince Sultan Military Medical City, Riyadh, Saudi Arabia
eBOYD, Birmingham, MI
fUniversity of Miami Miller School of Medicine, Miami, FL
gNYU Langone, New York, NY
hCentre Medical International, Monaco City, Monaco
iGalderma, Uppsala, Sweden
jHuntington Memorial Hospital, Pasadena, CA

Abstract
Restylane® Lidocaine is one of the most widely used hyaluronic acid (HA) fillers to replace lost or displaced volume during tear trough correction. Patient goals for tear trough correction include looking less tired or removing dark circles and this may be achieved by administering HA filler into the infraorbital region to correct the lower eyelid relative to the volume deficit, thereby smoothing the transition from the lower eyelid to the cheek. To achieve patient satisfaction and consistent results with Restylane, optimal application is essential; however, clinical guidance based on experience is limited. This paper reflects the recommendations of an interdisciplinary expert panel for the use of Restylane in correcting tear trough deformity, including patient selection, dosing, injection technique, and post-treatment care. Recommendations were discussed and agreed as a consensus, according to cross-sectional expertise and clinical experience.

J Drugs Dermatol. 2022;21(4):387-392. doi:10.36849/JDD.6597

INTRODUCTION

Tear trough (infraorbital area) hollow is a common age-related aesthetic concern, caused by volume loss or displacement, and a major reason for patients requesting periorbital rejuvenation.1,2 Hyaluronic acid (HA) fillers are commonly used to replace lost or displaced facial volume. With its clinical experience in facial rejuvenation of 25 years and over 50 million treatments (data on file), Restylane® has been successfully used as a targeted under-eye treatment in managing tear trough deformities.1,3-5

Effective facial rejuvenation with HA fillers requires a combination of precise anatomical understanding and injection proficiency. The tear trough is acknowledged as a significantly challenging area to treat, with a detailed anatomy that evolves with specific age-related changes.1,2,6,7

Significant clinical experience with Restylane has shown a lasting and effective reduction in facial wrinkles and has demonstrated its safety in many regions of the face.1,8 Restylane is suitable for the majority of patients with regular facial anatomy, although special precaution is necessary for patients previously injected with permanent or highly cross-linked fillers.8

This paper aims to provide recommendations for the optimal use of Restylane in tear trough rejuvenation based on the consensus recommendations of a highly experienced cross-specialty group of injectors.

Essential Aspects of Facial Anatomy
Several factors contribute to the appearance of tear trough deformity, including descent of the cheek, loss of facial volume, suboptimal infraorbital malar complex, and a muscular defect between the orbicularis muscle and angular head of the quadratus labii superioris muscle.2,7 A tear trough deformity itself may contribute to the appearance of dark shadows under the eye.1