Use of hyaluronic acid filler for tear-trough rejuvenation as an alternative to lower eyelid surgery

• Published in: Ophthalmic plastic and reconstructive surgery Vol. 27; no. 2; p. 69
• Main Authors: Morley, Ana M S, Malhotra, Raman
• Format: Journal Article
• Language: English
• Published: United States 01.03.2011
• Subjects: Adult; Aged; Cosmetic Techniques; Eyelids - drug effects; Female; Gels - administration & dosage; Humans; Hyaluronic Acid - administration & dosage; Hyaluronic Acid - adverse effects; Injections - methods; Male; Middle Aged; Patient Satisfaction; Prospective Studies; Rejuvenation; Retrospective Studies; Skin Aging - drug effects; Young Adult
• ISSN: 1537-2677
• DOI: 10.1097/IOP.0b013e3181b80f93

To describe one surgeon's experience with the use of hyaluronic acid gel (Perlane) as a tear-trough filler over an 18-month period and to assess patient satisfaction with the procedure. Consecutive, interventional case series involving case note review, masked grading of clinical photographs, and patient satisfaction survey. A total of 198 eyes of 100 patients were treated, with a mean follow-up of 5.1 months. Patients were principally female (87%), white (89%), and middle-aged (mean age = 47.8 years). Eight percent had previous lower eyelid blepharoplasty, and one had thyroid orbitopathy. The gel was placed preperiosteally, deep to orbicularis, anterior to the inferior orbital rim, with a mean volume of 0.59 ml per eye. The injection procedure was tolerable in 95% of patients without local anesthetic. Side effects described by patients included bruising (75%), swelling (26%), blue discoloration (4%), and lumpiness (33%). However, only 7% required dissolution with hyaluronidase. Eight percent requested additional hyaluronic acid gel within 3 months. Mean downtime was 1 day. Most patients (85%) described marked or moderate satisfaction with the treatment, 5% were ambivalent, and 10% were dissatisfied. This series confirms the effective use of hyaluronic acid gel (Perlane) in tear-trough rejuvenation. It has high patient tolerability, minimal complications, and high patient satisfaction. However, bruising, persistent lumpiness, or lack of perceived effect can lead to dissatisfaction in approximately 10% of cases.