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Tear Trough, Lower Eyelid Treatments

Written by Dr. Julian De Silva

Why Chose Dermal fillers for Lower Eyelid lift?

At The Centre many patients present to us with a shadow or depression that appears beneath the lower eyelid, this is often termed the tear trough. This appearance can give a tired appearance to the patients, and patients often find people comment, they look tired or stressed. The reason for these changes is often related to genetics and sometimes lifestyle (e.g. smoking).
The junction between our lower eyelids and upper cheek is referred to as the tear trough area. Tear trough hollowing is one of the earliest ageing changes and often is a common feature from childhood. As we get older, this area alters in appearance, by becoming more hollowed, darker, deeper and less revitalised. In some people depressions can develop can make the eyes look somewhat sunken and create unattractive dark shadows, giving the appearance of tiredness, exhaustion and old age.

There are essentially two ways in which this can be improved

  1. Non-Surgically with Tear Trough Filler
  2. Surgically with Lower Blepharoplasty (Eyelid Surgery)

Filler treatment is a popular solution for early treatment of these changes to the tear trough. The treatment involves carefully injecting a gel-like substance into specific areas around the eyes, with the objective of softening deep wrinkles and lines. Filler treatment to the lower eyelid is a more challenging technique and some non-specialist clinicians do not offer this treatment as it is more challenging than other parts of the face.

Filler can also be also combined with other treatments including wrinkle injection, as well as skin resurfacing and other facial rejuvenation techniques to provide a ‘liquid facelift’ or facial rejuvenation.

The Centre uses several different fillers for different areas of the face, each specialised for a particular anatomical area. There are a wide array of different filler preparations which are currently available on the market and at your consultation will advise you on which will provide the best aesthetic solution for you.

The treatment can result in bruising and swelling, technique is important in reducing recovery time. Dr. De Silva has customised a state-of-the-art no needle technique, this focuses on the use of a blunt cannula to provide the treatment, this minimises bruising and swelling to less than 5% of patients.
Infection is rare after filler treatment, care is required with hygiene and cleaning the skin before the procedure that avoids these issues. At the Centre we have not seen these issues occurs for more than 5-years and are rare. World-wide there have been some unfortunate serious complications from fillers to the tear trough area. Care is required with technique in this area to avoid complications and ensure a fast recovery.

When shaping the contours of the face the crystal-clear gel is injected into the skin in tiny amounts. A treatment takes a few minutes and the results can be seen immediately.

Lower blepharoplasty (eyelid surgery) can be used, however this anatomy is both intricate and detailed, for younger patients with mild changes, non-surgically offers a fast recovery procedure avoiding surgery. Patients with more advanced changes are better suited to lower blepharoplasty, as filler has limitations to improvement.

What does Tear Trough Filler involve at The Centre?

Dr. De Silva and his team will use a numbing local anaesthesia cream to reduce discomfort from the procedure. The numbing cream is specially made for Dr. De Silva and was designed in Beverley Hills and manufactured in Germany. After this a small anaesthetic injection is applied in the already numb area. The Dermal Filler is then used to augment the cheeks. At The Centre we used ‘Fast-Healing’ techniques that utilize a Cannula to administer the filler for most patients, this results in less swelling and bruising than older needle based techniques. Additionally, dermal fillers can be used on other facial areas at the same time as on the cheeks to give an enhanced natural result. At The Centre we specialize in ‘Natural Looking Results’, common areas for filler enhancement include the chin & jaw line, nasolabial folds, eye area (termed tear trough), the nose, and lip enhancement.

When will I see the Results from Lower Eyelid Fillers at The Centre?

At The Centre you can expect to see relatively ‘Instant Results’ with our filler treatments. There will be minor swelling after filler treatment that for most patients resolves over night, more rarely there can be mild swelling for 5-days (in approximately 5%). There is a small possibility, <2% of a minor bruise, this will resolve over a few days. We use the latest in technology to enhance recovery such as ‘No-Needle” Cannula techniques that enhance recovery. For most patients, the final results of cheek fillers will be evident approximately 5-days after the swelling subsides. With our techniques (Cannula based technique, application of filler at deeper levels) and filler choice will last 18 – 24 months, although results may vary from patient to patient.

Female face, before and after Lower Eyelid Treatments, eyelid, patient 2

Patient 1: “Tear trough filler can be completed to reduce hollowing and a shadow beneath the eyelid in younger patients with mild to moderate changes. Technqiue is important as with our use of a No-Needle Cannula technique, this speeds up recovery as 95% of patients have no bruising.”

Will I Look Natural with Lower Eyelid Fillers?

At The Centre, we specialise in Natural Looking Results. We believe in a natural augmentation of the Cheek Area. Dr. De Silva has pioneered research in the area of facial beauty and this has been published in the mainstream media and multiple TV Channels. Dr. De Silva developed the application of the Phi Golden Ratio (used in the many of the most famous Renaissance paintings of Leonardo Da Vinci) to the human face and has multiple trained specialists at The Centre to apply the principles of this facial Balance and Beautification. At The Centre we have treated many Celebrities and A-Listers with these techniques to enhance natural beauty, a term we describe as Beautification of the Face, enhancing the natural Phi Golden Ratio Lines. Of Key importance with Filler rejuvenation is avoiding excessive filler use as this no longer looks natural or beautiful, Key is application of filler in specific areas of the face that differ on each individual’s facial characteristics. The application of Filler is different in Masculine and Feminine Face, in women is focused along the Phi Golden Ratio lines of the Cheek, in men is focus along the lines of the chin and jaw line. If you have already had treatment that has been excessive it may be necessary to dissolve the existing filler or wait for the filler to resolve. At The Centre we specialise in Natural Looking Results.

Will I experience any discomfort or pain?

We use a combination of treatments to minimise discomfort, these include the use of a powerful numbing local anaesthetic cream that is specially made for The Centre. We use State-of-The-Art Cannula (no needle) technique to minimise discomfort. We use fillers that have incorporated anaesthetic into the injectable fillers to increase patient comfort. At The Centre we use additional numbing and vibration devises that use the Nobel Prize winning research on ‘The Gate Control Theory of Pain” to minimise discomfort. At The Centre, we take the above measures to ensure most patients only experience minor discomfort.

Are there any Risks or Complications?

Studies on safety of fillers have reported filler treatments as relatively safe with few side effects when completed by trained specialists. Recorded adverse events are usually minor including temporary injection site redness for less than three days. Patients may occasionally report temporary symptoms of redness, swelling, discomfort, lumps-bumpy changes, bruising, itching or change in colour. Infection is very rare however it is important that the treatment is completed in a CQC registered site (Care Quality Commission) and sterile precautions when having filler treatments. At The Centre all treatments are completed in our specialist Facial Centre on Harley Street.
A small proportion of patients (1%) do not suit fillers, the HA filler has properties that result in further swelling that gradually increases over months. For these patients, the filler should be dissolved and surgical lower blepharoplasty with fat transfer can be considered as an alternative.
Serious side effects such as damage to skin (termed Necrosis) or damage to vision have very rarely been reported. Dr. De Silva has pioneered the teaching of other doctors to avoid these serious issues in both National and International Conferences since 2012. Fillers are currently lacking from regulation, which remains a controversy in the UK. Precautions can be taken with competent practitioners to avoid these serious complications. Dr. De Silva has trained his team at The Centre to avoid these unfortunate issues by utilising modern safe and newer techniques.

Female face, before and after Lower Eyelid Treatments, eyelid, patient 3

Patient 1: “A hyaluronic acid filler can be effectively used to rejuvenate the lower eyelid area. Care is required to use a filler with non-absorbable qualities (termed ‘Hydrophilic”) this is key to avoiding swelling after treatment”

What Filler treatments are best avoided in the Lower Eyelids?

We use a combination of treatments to focus on a natural rejuvenation that is both safe, long lasting and safe. Over the last 5-years fillers have become more and more popular as both the quality of the filler product has reached new levels of quality and safety, in addition our techniques and skills at using them has matured with experience, Dr. De Silva has been using non-surgical treatments for patients for over ten years. At The Centre we believe that it is important to avoid potential issues, we believe that there are certain products that are associate with higher risks of issues, including permanent and semi-permanent fillers, as in some patients this can result in long-term issues. The lower eyelid is an intricate area of the face, and certain fillers should be avoided as they have properties that may result in increased swelling as well as lumpy-bumpiness all of which can be avoided. At The Centre we specialist in the face with knowledge of these fillers that are best avoided (including Juvaderm).

Some patients may have facial anatomy which is characterised by marked changes of their lower eyelids and these patients are better suited to a surgical correction including the use of lower blepharoplasty with fat transfer. At The Centre, Dr. De Silva a Specialist Facial Cosmetic & Plastic Surgeon is able to offer both Surgical and Non-Surgical treatments. Most clinics are only able to offer non-surgical treatment.

Tear Trough Lower Eyelid Filler Overview

  • Why? Rejuvenate natural loss of volume & Increased Beautification of your face
  • How? Longer acting HA-Fillers, Apply Phi Golden Ratio to give Natural results
  • Safety? Gold Standard FDA-Approved fillers, Cannula ‘No-Needle Technique’ Facial Specialist Expertise
  • Duration? 12 months (exact duration varies from person to person)
  • Cost? Quantity dependent, Average quantity 1-2 vials of Filler
  • Pain? Special topical Anaesthesia, Cannula Technique, Moderate discomfort
  • Risks? Mild redness, swelling (1-5days), occasional bruising
  • Recovery? Most patients normal activity next day
  • Complimentary Techniques? Fillers to Chin & Lips, Skin Rejuvenation
  • Alternative? We offer Long-term Surgical enhancement (Lower Blepharoplasty)

Aesthetics Awards London - Dr. Julian De Silva. Awarding Judge 2016,2017,2018RateMDs. Dr. De Silva is Rated Top 10 Cosmetic and Plastic Surgeons in the WorldTop Doctor - RealSelf

For further information on Filler Enhancement at The Centre please see:

Further Information

Further Information on Filler Treatments
Further Information on Signature Phi-Lift (Non-Surgical Facelift/ Beautification of Face)
Further Information on Signature Skin Rejuvenation (4x Combo-Technology, Fast healing)
Further Information on Filler Overview

Contact us to make an appointment for a Non-Surgical Treatments
FREE CONSULTATION call +44 (0) 020 8748 2860 or contact The Centre

Consultations with our surgeons and specialists are from £250 and are required prior to surgical treatment.

See The Centre’s FAQs on Filler Treatments

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