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Static and Dynamic Filler-Associated Tear Trough Deformities: Manifestations and Treatment Algorithm

  • Original Article
  • Eyelid Surgery
  • Published:
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Abstract

Background

Fillers are popular substances for the correction of tear trough deformity. Despite well-documented complications increasing gradually, standardized treatment algorithm for deformity secondary to improper injection is still limited.

Methods

Between April 2020 and April 2023, a total of 22 patients with filler-associated tear trough deformity with static bulges or dynamic swells after injection of tear trough were enrolled. For patients who received hyaluronic acid (HA) and unknown fillers, hyaluronidase dissolution was performed. For patients who received non-HA fillers and unknown fillers that failed to dissolve, a magnetic resonance imaging (MRI) examination was conducted. Surgical approaches were selected based on the filler distribution and the condition of the lower eyelid. Ligament releasement and fat transposition were accomplished when fillers were excised. Aesthetic outcomes were evaluated by double-blind examiners using the Global Aesthetic Improvement Scale after patients were followed up.

Results

In total, the study included 3 patients with simple static deformities, 1 patient with simple dynamic, and 18 patients with both. Fourteen patients underwent transconjunctival surgery and 8 patients underwent transcutaneous surgery, among which 18 patients underwent hyaluronidase dissolution and 8 patients underwent MRI prior to surgery. A total of 4 patients with self-limited complications recovered after conservative treatment. 90.9% of patients expressed satisfaction or high satisfaction with the treatment results.

Conclusion

Filler-associated tear trough deformities could be classified into static and dynamic deformities, which could appear separately or simultaneously. Treatment of deformities should be based on characteristics of fillers, in which MRI could serve as a promising tool.

Level of Evidence IV

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Funding

Lin Zhu received the fund for this study in the National High Level Hospital Clinical Research Funding, Grant No. 2022-PUMCH-B-041.

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Authors and Affiliations

  1. Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1#, Dongcheng District, Bei**g, 100730, People’s Republic of China

    Yuanbo Kang, Zenan **a, **nran Zhang, Nanze Yu, Zhifei Liu, **aojun Wang, **ao Long & Lin Zhu

  2. Peking Union Medical College, Chinese Academy of Medical Sciences, Dongdan Santiao 9#, Dongcheng District, Bei**g, 100730, People’s Republic of China

    Yuanbo Kang & Sifan Wang

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Contributions

YK wrote the manuscript. SW drew the figure and polished the manuscript. ZX and XZ collected and analyzed the clinical data. NY analyzed the magnetic resonance imaging data. ZL, XW, and XL participated in the design of treatment algorithm. LZ mainly designed this study and was responsible for all the procedures.

Corresponding author

Correspondence to Lin Zhu.

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The authors declare that they have no conflicts of interest to disclose.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Supplementary Information

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Supplementary Figure 1 Postoperative Questionnaire for Filler-associated Tear Trough Deformity. (JPG 792 KB)

Video 1 Patient with severe filler-associated tear trough deformities performs an unnatural or even wry smile. (WMV 12927 KB)

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Kang, Y., Wang, S., **a, Z. et al. Static and Dynamic Filler-Associated Tear Trough Deformities: Manifestations and Treatment Algorithm. Aesth Plast Surg (2024). https://doi.org/10.1007/s00266-024-04089-9

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