Tear trough rejuvenation
This 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 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 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 as a soft tissue filler in other areas of the face is very well established and associated with high patient satisfaction, its use for the management of “tear troughs” and, with Restylane Sub-Q, 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, after the application of a local anaesthetic cream, that offers immediate cosmetic results, a reduced risk of complications associated with surgery and a very short recovery period. Sub-Q is injected in the cheeks after giving a local anaesthetic injection, usually in the form of a dental block. Restylane can also be injected as a trial without removing the option of surgery at a later stage. The treatment is associated with mild discomfort and a short "down time". 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 result the Restylane 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 reduce the risk of bruising it is advisable to discontinue the use of aspirin 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). Excessive bruising can lead to staining of the Restylane gel in the lower eyelids and a blue discolouration of the skin although this occurs very infrequently.