Defying eye aging: What you need to know about tear troughs and fillers

November 3, 2024
Healthcaretoday, Aesthetic Medicine & Surgery Conference & Exhibition (AMSC), AMSC2024, Dr Tingsong Lim, Periorbital rejuvenation, anti-aging, tear trough fillers, youthful eyes, skin tightening, facial aesthetics, filler treatment, skin laxity, aging eyes, eye bag treatment, nasolabial fold, under eye treatment,
When it comes to aging, the eyes often give it away first. Signs such as under-eye bags, sagging skin, and drooping eyelids make us look older and more tired, affecting overall facial harmony. Dr Tingsong Lim, an expert in aesthetic practices, shared insights on these specific issues and innovative solutions during his recent talk at the Aesthetic Medicine & Surgery Conference & Exhibition (AMSC), titled “Periorbital rejuvenation with fillers: Why many failed?”

According to Dr Tingsong Lim (pix), while many seek treatment for the tear trough area, the tear trough itself isn’t inherently an issue; it’s a natural anatomical feature even present in babies. Rather, age-related skin laxity around the tear trough makes it appear deeper and more pronounced. This breakdown in skin elasticity causes the telltale signs of aging, such as sagging and ptosis (drooping) around the eyes.

Why the eyes show aging so early
One of the unique features of the periocular, or eye area, is that it ages faster than other facial regions. Research has shown that the skin around the eyes has higher levels of cellular senescence and lower DNA repair capacity, meaning it’s less able to regenerate itself after damage. This early aging is partly why signs like tissue ptosis—where eyelids begin to sag—often appear as early as the 30s or 40s, often asymmetrically.

"The periocular skin not only ages faster but also loses its ability to efficiently repair and regenerate damage," Dr Tingsong Lim explained. "This makes addressing eye-area concerns particularly challenging."

Misconceptions and overfill syndrome
A common misconception is that the fat beneath the eyes decreases with age, prompting many practitioners to overfill the area with fillers. In reality, certain fat compartments around the eyes actually increase in volume due to loosening. This shift, combined with skin laxity, can give the impression of volume loss even though fat volume hasn’t actually decreased.

Instead of addressing structural changes, many aesthetic practitioners add fillers directly to the tear trough or mid-cheek areas, often creating a “puffed” look rather than solving the underlying issue. This tendency has led to what’s known as “overfill syndrome,” where patients end up with excess fillers, resulting in bumps and bulging in the mid-face area rather than a natural lift.

“Overfilling the mid-cheek area often makes the nasolabial region even heavier,” Dr Tingsong Lim noted. “This can create an unbalanced look, as fillers shift and deepen the tear trough.”

Understanding the anatomy for effective treatment
Effective periorbital rejuvenation requires understanding the eye’s intricate anatomy, including fat pads, muscles, and septa (connective tissue that separates different compartments). Beneath the thin layers of skin and muscle lies a network of fat compartments that can shift as the face ages. The bone frame also changes, affecting the support structure for both skin and muscle tissue.

Dr Tingsong Lim emphasized that rather than simply adding fillers to fill perceived hollowness, it’s crucial to address tissue laxity by targeting the supportive structures underneath the skin. Only when the framework of connective tissue is stabilized can a more youthful, natural appearance be achieved.

Targeted filler placement: Precision matters
For those looking to enhance volume, Dr Tingsong Lim suggests a minimal and strategic approach. He recommends placing fillers in specific areas, such as the V-frame deformity—the region between the nasolabial and cheek fat pads—and the lateral pentel area, to create a subtle lift without exacerbating sagging.

By positioning fillers in these areas, the treatment can support soft tissue and achieve a tauter, smoother look without excessive bulking. "You only need 0.1 to 0.2 cc of filler in these strategic zones. This keeps the area around the eyes natural and prevents the dreaded overfill effect."

Addressing muscle and connective tissue aging
The muscles around the eye, particularly the orbicularis oculi, play a pivotal role in periorbital aesthetics. These muscles extend toward the temple and above the orbital rim, and they tend to weaken over time, leading to a sunken appearance.

Supporting these muscles requires filler placement around not just the tear trough but also the sides and tops of the eye area. Dr Tingsong Lim advocates for placing a tiny amount of filler in these less obvious spots, helping maintain a balanced and lifted look. Filling these regions also helps to restore fullness in the postorbital hollow, an area that becomes more apparent with age.

Complementary skin-tightening treatments
In addition to fillers, non-invasive treatments such as pulse radiofrequency and microneedling are excellent for addressing skin quality around the eyes. Radiofrequency, for instance, stimulates collagen production, tightening the skin and improving elasticity.

Ultimately, enhancing the skin quality is essential. It’s not just about filling volume but strengthening the skin structure itself, which is vital for long-term results.

Avoiding common mistakes in periorbital treatment
Many patients and practitioners alike overlook the importance of foundational support in periorbital treatments. Rather than focusing solely on volume restoration, the key lies in treating the underlying structural weaknesses. Dr Tingsong Lim suggests avoiding excessive fillers around the nasolabial area, as this often worsens tear trough visibility rather than improving it.

The success of periorbital rejuvenation hinges on combining careful filler placement with connective tissue support, skin-tightening techniques, and a nuanced understanding of eye-area anatomy. By shifting the focus from sheer volume to targeted support, aesthetic practitioners can help patients achieve natural-looking, youthful eyes without risking overfill syndrome.

Embracing a holistic approach to eye rejuvenation
Periorbital aging is a complex, multi-layered process, but advancements in aesthetic medicine offer new hope for achieving natural, balanced results. As Dr Tingsong Lim’s work illustrates, by considering both anatomy and science, patients can achieve rejuvenated eyes that are as expressive and youthful as they feel inside.

In today’s world of aesthetic possibilities, effective periorbital treatments can indeed help keep “the windows to the soul” vibrant, expressive, and youthful-looking without sacrificing natural beauty.

EXPLORE FURTHER

Eye stroke: Sudden painless loss of vision

The overlooked threat to vision and its silent symptoms