TTG Top Tips: Tear-trough filler

The under-eye area is one of the most bothersome and tricky-to-treat parts of the face. It’s at the root of why a lot of us feel we look tired or sad. Who better than ophthalmic plastic reconstructive and cosmetic surgeon Dr Sabrina Shah-Desai to demystify this complex concern? Read on for her best takeaways. 

1. Not all tear troughs are the same

If you don’t like the way your under-eyes look and you know about tweakments, you’ve probably considered tear-trough filler. But very few people are actually suitable candidates, and it’s one of the procedures that cosmetic doctors tell us they most commonly turn people away from.

This is because there are various reasons why someone may be unhappy with this area – you might describe it as hollowing, puffiness, ‘bags’ or discolouration – and there are many different factors that cause each of these concerns. Depending on the factors at play,  there is no one-size-fits-all treatment. especially because anatomically, the eye area is such a complex region.

‘Tear-trough filler can be a really good treatment for hollow eyes, but for many people, it’s not the solution to treating that zone,’ says Dr Sabrina. ‘The most important thing to realise is that there are many reasons why your under-eye area ages and multiple things that are happening.’

For example, the older you are and the looser and thinner the skin, the more likely you are to have large bags under the eyes, and in this case, filler isn’t the answer. And if the problem is puffiness under the eyes, filler isn’t for you either. In fact, hyaluronic acid filler will only make the puffiness worse, because the hyaluronic acid in the filler attracts and absorbs water.

2. Under-eye filler can give unwanted effects

Because of the way the muscles around the eye move, filler placed in one location can end up in another. ‘Because the muscles of the eye and the muscles of the mouth are constantly moving, they can cause migration of the filler,’ says Dr Sabrina. Also, the eyelid lymphatics are not robust, so they can start swelling. These lymph channels may not swell initially, but they may swell 12 months down the road. Even though we’ve been doing under-eye fillers for such a long time, it’s only over the last two years that we are beginning to understand what the delayed complications can be,’ she adds.

3. Skin laxity and filler doesn’t mix

Tear-trough filler is best for younger people – the under 50s –  who don’t have skin and tissue laxity. What’s tissue laxity? It’s that wrinkly, crepey or saggy skin under the eyes. ‘If someone is older and they have skin laxity, [if you inject filler] they’re going to swell and get what is known as festoons or malar bags, it’s like a second bag,’ explains Dr Sabrina. ‘This is because if the under-eye skin is very thin – and if we see this more in Caucasian skin – it will not be able to hold onto the volumes of filler that are being put in, and it will swell.’

4. There are other options

If it sounds like filler isn’t going to be the solution for your under-eye issues, there are other tweakments that can give a great result. ‘There are indirect ways of treating the under-eyes,’ says Dr Sabrina. ‘Once you are in your mid to late thirties, you start to lose volume in the cheek. So, an indirect way of supporting your under-eye is treating the cheek [with filler].’

And if it’s under-eye wrinkles that are bothering you, tightening up the skin will help. ‘If you look at why the under eyes look tired, one of the reasons is that if you have very wrinkly skin, it’s not going to reflect light uniformly,’ says Dr Sabrina. ‘You need a nice [taut] sheet to reflect light, so you can tighten the skin and light will reflect beautifully under the eyes.’

Good options for this are certain types of lasers, radiofrequency microneedling, traditional microneedling or even under-eye peels. Tixel also works well as it can be taken right up to under and around the eyes. Energy-based devices that tighten the skin and smooth out wrinkles by way of increasing collagen production will also help to thicken the skin. ‘When the skin is thin it shows the underlying blood vessels and the muscle colour, and so it can look darker because it’s just thin skin and you’re seeing the underlying tissues. So that’s where these energy-based treatments can really help fix under-eye issues.’