The area around the eyes is an indicator of a person's chronological age, general condition and physical attractiveness. The nasolacrimal sulcus is a depression in the area of the lower eyelid, in the presence of which the patient looks older than he really is, and has a tired look.
Ethnicity, age-related volume loss, skin changes (thinning, hyperpigmentation, translucence of superficial vessels) – factors affecting the severity of the nasolacrimal sulcus.
At the same time, a soft transition from the preseptal to the orbital part of the circular muscle of the eye and from the lower eyelid zone to the upper zygomatic zone – a sign of youth and attractiveness. Dr. Tayyab Bhatti explains how to achieve this effect with HA fillers.
Lacrimal trough correction with HA fillers: product and instrument selection
There are many methods for correcting the nasolacrimal trough, including the use of cosmeceuticals, platelet-rich plasma, microneedling.
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However, in his practice, the author most often uses Teosyal Redensity II (RD2) – the first filler specifically designed for the correction of the nasolacrimal trough, which, when properly injected, is not prone to migration and the formation of tubercles. This product is composed of cross-linked and non-cross-linked hyaluronic acid chains, which ensures its unique properties and uniform integration into tissues.
In one procedure, the author uses a maximum of 1 ml of Teosyal Redensity II filler to work on both sides of the face.
For the filler injection tool, when working with young patients who have fairly good skin tone, the author prefers to use a 30-gauge needle to deliver small boluses of HA. With patients over 50 years of age, to reduce the risk of bruising, the author uses a 38 mm 27 or 25 gauge cannula.
Filler Correction: Rules for Safe Work in the Periorbital Area
A case report: correction of the nasolacrimal trough with HA fillers
A 28-year-old female patient came to the clinic complaining of dark circles under her eyes. During the consultation, the author recommended that the patient perform a correction of the nasolacrimal sulcus with HA fillers. Prior to injections, the area under the eyes was cleansed with Clinisept+.
2. During the procedure, the patient was in a chair at an angle of 45 degrees and looked up – this position provides maximum comfort and accuracy of correction.
3. First, the drug was injected into the deepest part of the furrow. The needle was inserted perpendicular to the skin in the most lateral part of the sulcus (the direction of the cut of the needle – in the opposite direction from the eye).
4. Working in the periorbital zone, the author does not conduct an aspiration test, but immediately proceeds to slowly introduce approximately 0.05-0.1 ml of filler into the periosteum, under the orbicular muscle of the eye. After that, the author removes the needle and slightly presses on the treated area.
To avoid medial migration of the filler, do not inject the product over the orbicular muscle of the eye.
5. At this stage, do not quickly remove pressure from the treated area, as this is fraught with the appearance of hematomas.
6. The subsequent injection was carried out at points located medially in relation to the initial one.
The linear insertion technique is excellent for correcting the nasolacrimal sulcus of moderate and significant severity. 0.5 ml of filler was used to correct one side.
During insertion, it is important to ask the patient about possible pain or visual impairment – in such cases, it is necessary to immediately stop the administration of the drug.
Fig. 1: before (top) and after (bottom) correction of the nasolacrimal trough with HA fillers for 4 hours after the correction, if possible, be in a vertical position;
• do not drink alcohol for the rest of the day;
• refuse to visit the solarium or sauna.
When the filler is injected under the orbicular muscle of the eye, the effect of the procedure is maintained for 12-15 months.
Results:
Adapted from Aesthetics
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