What is the best treatment for tear troughs?

Best Treatment Options for Tear Trough Deformity

Bio-Filler (autologous platelet poor plasma gel) is the most effective treatment for tear trough deformity, showing significant clinical improvement with minimal side effects and lasting up to 3-6 months. 1

Understanding Tear Trough Deformity

Tear troughs are depressions that form between the lower eyelid and cheek, often appearing as dark circles or hollows that contribute to a tired or aged appearance. The periorbital area is one of the first to show signs of aging due to its thin, delicate skin.

Treatment Algorithm

First-Line Treatment: Bio-Filler (Autologous Plasma Gel)

1. Preparation process:

   • Draw peripheral blood and centrifuge for 8 minutes at 2000g
   • Collect platelet-poor plasma (PPP) from upper layer
   • Heat PPP at 75°C for 10 minutes to create albumin gel
   • Cool to room temperature
   • Mix with liquid PRF (platelet-rich fibrin) including buffy coat layer 1

2. Administration:

   • Use 25-gauge needle or large bore cannula
   • Inject into tear trough area
   • Typically requires one treatment session with effects lasting 3-6 months 1

3. Advantages:

   • Cost-effective and safe
   • Well-tolerated with minimal invasiveness
   • Significant esthetic correction
   • Autologous (using patient's own blood) reducing risk of allergic reactions 1

Second-Line Treatment: Hyaluronic Acid (HA) Fillers

1. Technique:

   • Cannula approach preferred for safety (reduces risk of vascular complications)
   • Supra-periosteal placement
   • Average volume: 0.4-0.65ml per side 2, 3, 4

2. Effectiveness:

   • High satisfaction rate (75-95%)
   • Results last 10-12 months 3, 5
   • Improvement of 1-2 grades on severity scales 3

3. Risks:

   • Minor: bruising, erythema, swelling, pain at injection site 4
   • Major: vascular occlusion (rare with proper technique) 6

Comparative Effectiveness

Bio-Filler has shown superior results in direct comparison studies:

• A case series of 52 females with tear trough deformity demonstrated significant clinical improvement after Bio-Filler injection 1
• Results were measured objectively using the Tear Trough Rating Scale and maintained throughout the 3-month follow-up period 1
• Another study showed significant decrease in tear trough severity after plasma gel injection compared to pre-injection 1

While hyaluronic acid fillers show good results with 95% patient satisfaction 5, they carry higher risks of complications and are not autologous, making Bio-Filler the preferred first-line option.

Clinical Pearls and Pitfalls

For Bio-Filler:

• Eliminate bubbles before heating upper layer of PRF
• Ensure heated albumin gel cools before mixing with liquid PRF
• Use firm luer-to-luer connection and mix slowly
• Ensure no dead space in connection by pushing liquid through 1

For HA Fillers:

• Tear trough is considered the most challenging area to treat with HA fillers 6
• Should only be performed by experienced specialists
• Vascular danger zones must be avoided to prevent serious complications 3
• Using cannula technique significantly reduces risk of vascular complications 2

Special Considerations

For patients with post-inflammatory hyperpigmentation in the tear trough area:

• Consider adding topical treatments like hydroquinone 4% cream twice daily
• Add retinoid at night to enhance penetration
• Ensure strict sun protection with SPF 70+ 7

For patients with concurrent blepharitis affecting the tear trough appearance:

• Address eyelid hygiene with warm compresses and cleansing
• Consider topical anti-inflammatory agents if inflammation is contributing to appearance 1

The evidence strongly supports Bio-Filler as the optimal treatment for tear trough deformity due to its safety profile, effectiveness, and autologous nature, making it the recommended first-line approach for this common cosmetic concern.