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Accordingly, my strategy in treating this patient was to replace the facial volume, as well as to improve dermal thickness and elasticity in this area. By replacing the volume in the mid-cheek deep fat compartments, it’s possible to create adequate support to the tear trough area with an indirect approach and, based on my experience filling this area, improves infraorbital hollows indirectly.
Treatment options
Case Study: Rejuvenating the Periorbita Nurse prescriber Anna Kremerov describes successful treatment of the under-eye area using a non-direct approach Assessment A 52-year-old female patient presented to my clinic with concerns of dark under-eye circles and acute skin laxity in the infraorbital area, following years of yo-yo dieting, lack of sleep and stress. She asked for a tear trough correction to achieve the desired outcome. She was otherwise healthy, with a history of light smoking. When I assessed her full face, I could see she has a good lateral cheek projection. However, she was quite clearly hollow in the anterior cheek, and this had exacerbated her under-eye appearance. In addition, her overall tired look was enhanced by facial laxity and formation of superficial rhytids in the infraorbital region. Following assessment, I concluded that a single treatment with a direct approach to treating her tear trough area could fail to meet the patient’s desired aesthetic outcome, and a different approach was needed to achieve the long-lasting periorbital and facial rejuvenation, along with
natural-looking results. It’s imperative to understand that the cause of tear trough deformity is multifactorial, and isolated treatment may not be sufficient to achieve a good aesthetic outcome.1 The main components of the tear trough are the periorbital hollow itself, superior fat bulge, a distinct change of skin colour and skin thickness in the eyelid-cheek junction.2
Different approaches, along with their advantages and disadvantages were discussed in detail with the patient. A twoweek cooling-off period was implemented before agreeing to go ahead. It was important that she could think carefully about each of her options, weighing the benefits of each against the possible risks and side effects. Options presented included collagenstimulating filler, hyaluronic acid-based fillers, botulinum toxin injections, skin boosters and mesotherapy, skin resurfacing procedures such as IPL treatment and laser skin resurfacing. All of them are excellent treatments; however, when I asked the patient about her eye area, she mentioned that she gets swelling of the region in the morning. Added to the poor elastic recoil, this made me reluctant to treat her tear trough area directly with HA filler, as per my original plan. While the patient knew very little about collagen depletion, she was keen to learn more about how a collagen-stimulating filler could help. Unlike HA, PCL particles cannot be dissolved so I explained this thoroughly to her, paying special attention to the product specification. She was then happy to proceed with the recommended course of treatment. She was informed of the possible risks prior to the procedure, and an individual treatment plan was defined prior to the procedure. My product of choice was Ellansé M. This is because it works not only by volumising and correcting superficial rhytids but also
It’s imperative to understand that the cause of tear trough deformity is multifactorial and isolated treatment may not be sufficient to achieve a good aesthetic outcome
Reproduced from Aesthetics | Volume 7/Issue 5 - April 2020
