Dr Manoj Bagwandeen provides some eye-opening insight into the treatment of the tear trough area – one of the most requested non-surgical procedures in aesthetic medicine.
It is said that the eyes are the windows of the soul – as they often reveal one’s emotions and inner state of mind. In some cultures, eye contact is mostly seen as a sign of sincerity, with others taken as a challenge to authority. Our eyes are also used to convey different feelings: love, anger, admiration, sadness, joy.
Having an eye-opener means that you’ve just had a wake-up call while being ‘easy on the eye’ signifies that someone is very attractive. Suffice to say, the eyes are often the most noticeable and expressive features on the face – and, regrettably, the one that is also most susceptible to the signs of ageing.
Facial ageing at work
The ageing process stealthily starts with tell-tale crinkles around the eyes, divulging all the laughter and twinkle you have experienced in your life. These tiny pronged lines are a natural part of growing older, along with a decrease in skin laxity and a marked loss of volume around the eye area. Furthermore, fat from the eyelids settles into the eye sockets, while the lower eyelids slacken and bags start developing – thus making the eyes appear sunken and tired (even after a good night’s sleep).
Indeed, this hollowed, weary appearance is one of the most common complaints amongst patients who are looking for facial rejuvenation. Fortunately, there’s now a myriad of non-surgical procedures available that are effective in restoring a youthful look.
Facial injectables
Botulinum toxin injections are a marvellous way to treat crow’s feet – the muscles around the eyes relax so that the lines are softened, preventing them from getting deeper. Yet the area under the eye presents a challenge to the aesthetic doctor. Because profound hollowing and dark shadows are a cause of concern to many patients, a common request is to treat the tear trough. This is a well-defined, indented zone – extending outward from just below the inner part of each eye – to the lower part of the ear on the same side.
Dermal fillers, administered by registered doctors, have become the treatment of choice for improving the tear trough. If you have decided to do something about your under eyes, here’s what to expect:
Firstly, what causes hollows, bulges, and dark circles?
We are all unique beings, so your doctor should be able to assess your personal condition. Treatment for each cause can vary significantly. The main factors being:
Genetics
There is an increased tendency for persons of certain ethnicities or genetic backgrounds to have prominent tear troughs due to an underlying ligament excessively tethering the overlying skin. If you are of Middle Eastern, Mediterranean or Indian descent, your chances of having a deeper tear trough are higher
The ageing process
Whilst ageing is visible on our skin, it affects all the different components and sub-structures that make up our face. A progressive loss of bone around the eye (orbit), combined with the loss of supporting fat tissue contribute mostly to the hollowed-out look seen with advanced age or severe illness. The numerous ligaments that previously retained the soft tissues in the area also become lax, leading to bulging of the under-eye fat pads they once held back more effectively – like a hammock that has seen better days.
Pigmentation
Often mistaken for being an actual tear trough, excessive pigmentation simply enhances the appearance of those dark circles, and is commonly seen in persons with darker skin tones or people with chronic sinus problems and eczema. Extremely light/fair skin can also manifest dark circles, but these are caused by light reflecting through the thin skin and off the superficial blue veins (these are found in abundance under the eyes).
Secondly, what can be done?
Hyaluronic acid fillers are most often used to correct the lost volume and hollowness under the eyes, including filling the tear troughs. Results are immediately apparent and usually last between 10-12 months, but this can vary between patients. Your doctor will provide you with more information on the product used and the factors that influence the longevity of the filler.
Using an appropriate, soft filler to treat this sensitive area is vital, as is the correct placement under the skin. It is essential not to use firm hyaluronic acid fillers or permanent / semi-permanent fillers in this area as they are associated with higher side effects and risks.
There is a dermal filler registered and available in South Africa which is specifically designed to be used in the tear trough and under-eye area (this filler mentioned is available from Genop). This filler has numerous skin-boosting supplements built-in to further improve the condition of the overlying skin.
Now, whilst it’s important that your attending aesthetic doctor is well trained in assessing your concerns and distinguishing between the various causes, this becomes absolutely crucial when performing the treatment. In South Africa, only medical doctors fully registered with the HPCSA (Health Professions Council of South Africa) are permitted to perform these procedures – and must be done in a proper medical setting (definitely NOT in your lounge, local spa, or hair salon!)
Since this is a medical procedure, there is always a risk involved – so it’s best to do some research and verify your doctor’s qualifications beforehand. Go to a referred doctor who is not only experienced but who also conducts their practice appropriately. Find a doctor practising aesthetic medicine in South Africa by visiting www.aestheticdoctors.co.za.
Before treatment and six weeks after treatment with hyaluronic acid filler. (Please note: the patient has been treated by Dr Manoj Bagwandeen and have given permission to have their pictures, as depicted, used in A2 Magazine and teaching materials).
What can go wrong?
Blockage of blood vessels
Whilst this is perhaps the most serious complication, if the procedure is performed as I suggest above, it is a very rare one and has the same risk as injecting filler into your lips. Blockage of an artery with filler may lead to damage to the overlying skin and is even known to have occasionally caused blindness and strokes. Any doctor performing these procedures must be trained to identify this complication, and to be able to administer the prescribed reversal medication (hyaluronidase), as well as any other intervention to minimise any potential damage.
Infection or the formation of lumps under the skin
This can occur at any time after treatment – even years later. Again, ensure that these procedures are performed properly from the outset, and treated effectively if it happens.
Tyndall effect
This is when the filler is visible under the skin because it was injected too superficially – seen as a blue/grey discolouration. This can be reversed with hyaluronidase, but this may also dissolve all the filler away.
Bruising
Can be a common feature due to a rich blood supply in the area. It’s not too much to worry about – apart from the cosmetic appearance – and often resolves within a few days (fortunately it can also be concealed with make-up). It’s best to not take any ‘blood-thinning’ products in the two-three days prior to your treatment, which you must discuss with your doctor.
Excessive swelling of the area
Caused using an inappropriate filler; the filler being injected in the incorrect area or too much filler being used.
What to expect during the procedure?
Your treating doctor would have assessed you and determined an appropriate treatment together with the correct filler choice. You must give your doctor consent to perform the treatment after being fully informed about the procedure and the risks/benefits involved. Placement of the filler can be done via a sharp needle or a blunt cannula – each doctor has their own preference, but using a cannula is generally considered the safer option.
Given that the area is sensitive, a topical anaesthetic medication can be applied before to numb the area. Most fillers have a local anaesthetic combined into the filler, so soon after injection, the area becomes numb and stays pain-free for a few hours. Once the area is properly disinfected, the treatment is performed relatively slowly and with extreme care. Both sides are usually done within 20-30 minutes.
Before treatment and six weeks after treatment with hyaluronic acid filler. (Please note: the patient has been treated by Dr Manoj Bagwandeen and have given permission to have their pictures, as depicted, used in A2 Magazine and teaching materials).
What happens after?
There is usually no downtime from the procedure. You should see an immediate result, but it may take between 10-14 days to appreciate the full outcome. It is not advisable to apply make-up for an hour or two after the procedure, as this increases the risk of infection. The filler will eventually spread out and blend in with your own tissue before exerting the full effects. During this time, there may be some swelling and puffiness, especially after awaking.
This usually settles within the first two weeks. Your doctor should reassess you after 10-14 days, and only then carry out any corrections that may be needed. Perhaps a bit more filler is required to optimise your result. Pain medication is usually not needed after treatment, however, should you develop any severe pain, changes in your sight or changes in the colour of the skin (in or around the area treated), you must inform your doctor immediately. Do not apply any pressure, or have any other facial treatments done until advised by the doctor.
Take home message
Under-eye circles and hollows can be effectively banished with the use of a tried and tested product: hyaluronic acid dermal filler, which is administered by a qualified, registered doctor. Results are more often than not very pleasing, with the patient not only looking better but feeling more confident too. Which is exactly what the doctor ordered: a healthy boost to one’s self-esteem – and most importantly – bringing back that shiny twinkle in your eyes.
Written by Dr Manoj Bagwandeen
Dr Manoj Bagwandeen
MBChB, Advanced Diploma in Aesthetic Medicine (cum laude)
- Director and medical doctor of Dr DH Bagwandeen and Associates Incorporated: www.capemac.co.za
- Member of: HPCSA, AAMSSA, SAMA, DASIL, SASDS, SAG, SAAGS
- Board certified by the AAAM
Editorial Disclaimer: this article was commissioned by Genop Healthcare. For more information on the range of fillers distributed by Genop and the doctors that use them, contact www.genop.co.za
A2 Disclaimer: This article is published for information purposes only, nor should it be regarded as a replacement for sound medical advice.
Issue 34 – September 2020 (Spring)
This article was written by Dr Manoj Bagwandeen and edited by the A2 team EXCLUSIVELY for the A2 Aesthetic & Anti-Ageing Magazine Spring 2020 Edition (Issue 34). All original articles are owned by LeWeb Media PTY Ltd, to make use of any of our content for re-publishing, kindly contact us for approval info@a2magazine.co.za
A2 Magazine prints only four magazines each year – reporting seasonally on everything you need and want to know about aesthetics, anti-ageing, integrative medicine, quality and medical skincare, cosmetic dentistry and cosmetic surgery in South Africa – where to go, who to see, what to expect, something new and so much more! Never miss an edition – click here for more info about where you can buy the print and/or digital copy of A2 Magazine (including back copies).