Tear Trough Restylane Injections

This relatively new non-surgical treatment is appropriate for some patients with lower eyelid dark circles/dark hollows (also referred to as “tear troughs”). In the lower eyelid a weakening of the orbital septum, and in the cheek area (the “mid-face”) a loss of soft tissue volume, tend to accentuate the appearance of the lower bony orbital margin which lies between the lower eyelid and the cheek. This also leads to the appearance of lower eyelid fat pockets and together these can lead to a “tear trough” depression, or dark shadow or hollow.

Not all patients who complain of lower eyelid dark circles or dark hollows are suitable for surgical improvement, usually in the form of a lower eyelid blepharoplasty or eye bag removal. The use of Restylane or Juvéderm injections offers some patients a less invasive alternative treatment for their problem as shown in example 1. Some patients also benefit from Restylane Sub-Q or Juvéderm Voluma injections which help to restore a youthful shape to the face by filling the inner and outer part of the upper cheeks as shown in example 2. This patient has also undergone anti-wrinkle botulinum toxin injections to her forehead with an improvement in forehead lines and brow shape.

Although the use of Restylane and Juvéderm as soft tissue fillers in other areas of the face is very well established and associated with high patient satisfaction, their use for the management of “tear troughs” and, with Restylane Sub-Q or Juvéderm Voluma, the management of a loss of soft tissue volume in the mid-face is proving to be a very good new application for many patients. The effects of the injections last approximately 6-12 months before repeat injections are required. The treatment is undertaken as an outpatient procedure that offers immediate cosmetic results, a reduced risk of complications that are associated with surgery and a very short recovery period. Restylane Sub-Q, or Juvéderm Voluma can also be injected into the cheeks. Restylane can also be injected as a trial treatment without removing the option of surgery at a later stage. It can also be used for patients who have previously undergone cosmetic eyelid surgery and have some residual hollowing of the lower eyelids.

The treatment is associated with mild discomfort and a short "down time". The injections also contain lidocaine, a local anaesthetic, which helps to minimise any discomfort. Bruising and swelling usually take a few days to subside.

Occasional contour irregularities can occur following the injections. These are managed with massage after applying Auriderm cream. If a patient is dissatisfied with the results, the Restylane or Juvéderm can be dissolved with the use of a small injection of Hyalase (an enzyme commonly used in local anaesthetic solutions given around the eye in patients undergoing cataract surgery). In order to minimize the risk of bruising it is advisable to discontinue the use of Aspirin, Anadin or any anti-inflammatory medicines e.g. Indomethacin, Ibuprofen, Diclofenac, Voltarol, for 2 weeks before treatment provided it is medically safe to do so (please discuss this with your GP or physician if in doubt about this). It is quite alright to take Paracetamol. Excessive bruising can lead to staining of the Restylane gel in the lower eyelids and a blue discolouration of the skin. This occurs rarely but is the reason why it is important to avoid medications which predispose to bruising.

This treatment has proved popular with both men and women of ages ranging from 21 to 55 years of age. A consultation is important to ascertain a patient’s suitability for this treatment. In the hands of an experienced oculoplastic surgeon, the risks and potential complications are very small but these must be considered carefully following a discussion at a consultation before proceeding with the treatment.

It is always preferable not to plan the treatment on the same day as the consultation but to have time to reflect on the discussions first and return for the treatment on a separate occasion.

Consultants who undertake this procedure:

Saj Ataullah
Anne Cook
Brian Leatherbarrow