PEER-REVIEW | FACIAL AESTHETICS | A beautiful glance lights
up the face. Enhancement and filling of the tear trough will embellish the luminosity of the glance and overall appearance.
muscle and whether the muscle is compact and dissociated). Scales 2 and 3 can be divided into two sub-points, which
take into consideration the loss of tonicity with ageing: ■ Young patients with compact and homogenous muscle without gaps
■ Older patients with a loss of tonicity of the orbicularis oculi muscle, with less compact, less homogenous, dissociated fibres possibly producing gaps between them. Therefore, the classic three-point scale becomes an
original five-point scale, which takes into consideration the tonicity and homogeneity of the orbicularis muscle with ageing: ■ Scale 1: no groove ■ Scale 2A: moderate tear trough in young people ■ Scale 2B: moderate tear trough in older people ■ Scale 3A: marked tear trough in young people ■ Scale 3B: marked tear trough in older people. This classification will help the physician to precisely
Key points
■ The hollowing of the palpebral groove, forming a tear trough, is a prominent sign of ageing but can also be seen in young people owing to hypoplasia
■ Successful treatment of the tear trough requires an understanding of the anatomy, physiology and morphological changes induced by ageing
■ The correct technique for filling with hyaluronic acid is paramount to avoid adverse effects
■ A five-point scale can be used to ascertain the optimal treatment protocol
■ Continued research and development will provide dedicated products to attain even better results with a lessened risk of adverse events
26 ❚
■ Scale 1: no groove ■ Scale 2: moderate groove ■ Scale 3: marked. Physicians should understand the changes that occur
with ageing: the muscle extends downward, following the sagging of the superficial malar fat and the skin. It becomes less compact, less homogenous, and with gaps between the dissociated fibres. An original and more scientific classification is
therefore proposed, incorporating these anatomical and dynamic points (i.e. the tonicity of the orbicularis
decide on treatment protocols and precautions to be taken.
In scales 2A and 3A, an injection performed with
expertise ® adequate amount of product deeply and gently placed under the muscle, with a gentle pressure on the plunger of the syringe ® presents a minimal risk of the Tyndall effect as the orbicularis oculi is tonic and homogenous, acting as a compact barrier. In scales 2B and 3B, a less compact orbicularis oculi
muscle with dissociation of its fibres can have gaps, allowing superficial migration of the product ® even with
Figure 6 Where to inject in the tear trough: deep at the level of the palpebromalar groove, in front of the bony orbital rim, and just behind the orbicularis muscle
January/February 2013 |
prime-journal.com
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