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TOTW Ep 8: Tear trough filler for under-eye hollows

8th November 2019

patient before and after tear trough treatment

Sunken hollows beneath the eyes are the bane of many people’s lives and can give you an ‘always tired’ look. They come about due to a loss of volume in the under-eye area, also called the ‘tear trough’. Careful placement of a lightweight filler gel made from hyaluronic acid can fill in this sunken area and offset the appearance of hollowness.

Tear-trough work is all about creating a smooth junction between the lower eyelid and the cheek. It sounds simple enough, but it’s actually a rather tricky treatment to pull off successfully.

In this week’s Tweak of the Week, leading cosmetic doctor Dr Saleena Zimri shows how it can be done – using Perfectha Fine Lines, which is a hyaluronic acid-based filler that works particularly well in the delicate under-eye area.

You can watch the video of the procedure here – or you can read the transcript, below.



Alice talks to Dr Saleena Zimri 

AHD: Saleena, you are an expert cosmetic doctor, under eye treatments have become one of your big things, haven’t they?

SZ: When I started this business about 10 years ago tear troughs was just emerging as a treatment and people were using fillers in the simple lines, and then we discovered we could fill hollows under the eyes and I was one of the first doctors that started experimenting with this, in the north certainly.

AHD: This is a really popular procedure and one I find people are really intrigued by because so many of us have problems with dark circles – could you talk a bit about who it works for and who it doesn’t work for?

SZ: I suppose the commonest mistake I see is people who come in who think it’s going to treat discolouration under the eyes. It’s not going to treat pigmentation around the eyes – dark circles can mean a lot of things, it can mean colour, it can mean lines, it can mean hollowness, and really what we’re treating with tear trough is the hollowing and the volume loss under the eyes.

AHD: And choosing the right product for the tear trough is important as well because this is such a delicate area. The skin is so thin you’ve got to have something that’s nice and flexible under there, is that why you like the Perfectha Fine Lines for it?

SZ: Absolutely. They’ve got a range of products but I always use the finest products because under the eyes, we’ve got very little fat in the skin in the lower lid, you need a fine product that will essentially fill the gap but also be quite delicate and sensitive to the fact that we have a lot of structures with water-retaining abilities around the eye.

AHD: How long does it last for?

SZ: A long time actually and often I’m having to send people away who are coming back quite soon, I would say the average patient sees results for about 18 months to 2 years.



AHD: Ellie, you have kindly stepped up to be our patient today for the tear trough work, so what’s made you think of doing this?

Ellie: Well I’ve always had really hollow eyes and most mornings I have to wake up about 20 minutes early so I can do my concealer, set it with powder, more concealer and if one morning I don’t do that, people say oh something’s wrong with you …


PRE-tear trough PROCEDURE

AHD: So is Ellie a good candidate for this procedure?

SZ: Yes, we’ve chosen Ellie because she is obviously quite young, as we get older we do have sort of baggy skin, looser skin and more fat protrusion under the eye, usually with those kind of people, depending on the size there not really the best candidate. However Ellie’s got a nice hollowing region under the eyes, she has got some colour issues in the corner of the eye, which is usually due to thin skin. There’s not very much fat under the lower lid, which can show the bluey, purple-y colour of the muscle underneath.

AHD: Saleena, what do you need to explain to Ellie before you start on this procedure?

SZ: Usually I just explain that were going to use a cannula, it’s a blunt instrument [like a needle], and I do need to make an entry hole using a sharp needle to allow the blunt instrument to go into the skin and underneath the muscle and that can feel a bit tight and a bit ‘rummagy’, a bit of tenderness but its not usually very sharp or painful. So what I do is something called a retrograde fill, and I can just see a little bit of filler as it’s going in and I can feel the cannula under my finger so I know I’m in the right place. So I slowly inject as I’m pulling the cannula out. The product is really mouldable so if you feel like you have a bit of excess, you can just smooth it out.


tear trough filler with Perfectha – the RESULTS

AHD: Saleena, this looks like a really nice result for Ellie… Is this what you were expecting?

SZ:  It’s even better than I expected. I do this procedure nearly everyday and when someone has quite thin skin under the eyes it is hard to see the results straight away. It can take a week or two to see the difference, but actually for Ellie you can already really see the improvement in the groove all the way around the eyes – right up until the end of the cheek bone.


tear trough filler – AFTERCARE

AHD: Now what about aftercare? What does Ellie need to know?

SZ: The main things are that there will be a bit of redness and swelling. I don’t want Ellie to do any kind of high intensity activities, so heavy exercise or anything that makes her red in the face, nothing like that for the next few days. And she needs to be make-up free for 24hrs. It will be fine to wear makeup tomorrow, by then the tiny little holes from the cannula will be sealed  shut,

AHD: So Ellie do you think your friends will notice?

Ellie: Only time will tell really, I’m not going to tell them!




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