title: Use of hyaluronic acid filler for tear-trough rejuvenation as an alternative to lower eyelid surgery.
abstract: OBJECTIVE
  To describe one surgeon's experience with the use of hyaluronic acid gel (Perlane) as a tear-trough filler over an 18-month period and to assess patient satisfaction with the procedure.
  
  
  METHODS
  Consecutive, interventional case series involving case note review, masked grading of clinical photographs, and patient satisfaction survey.
  
  
  RESULTS
  A total of 198 eyes of 100 patients were treated, with a mean follow-up of 5.1 months. Patients were principally female (87%), white (89%), and middle-aged (mean age = 47.8 years). Eight percent had previous lower eyelid blepharoplasty, and one had thyroid orbitopathy. The gel was placed preperiosteally, deep to orbicularis, anterior to the inferior orbital rim, with a mean volume of 0.59 ml per eye. The injection procedure was tolerable in 95% of patients without local anesthetic. Side effects described by patients included bruising (75%), swelling (26%), blue discoloration (4%), and lumpiness (33%). However, only 7% required dissolution with hyaluronidase. Eight percent requested additional hyaluronic acid gel within 3 months. Mean downtime was 1 day. Most patients (85%) described marked or moderate satisfaction with the treatment, 5% were ambivalent, and 10% were dissatisfied.
  
  
  CONCLUSIONS
  This series confirms the effective use of hyaluronic acid gel (Perlane) in tear-trough rejuvenation. It has high patient tolerability, minimal complications, and high patient satisfaction. However, bruising, persistent lumpiness, or lack of perceived effect can lead to dissatisfaction in approximately 10% of cases.
authors.affiliation: Queen Victoria Hospital, East Grinstead, United Kingdom.
authors.forename: Ana M S
authors.initials: AM
authors.lastname: Morley
authors.forename: Raman
authors.initials: R
authors.lastname: Malhotra
mesh_terms: D000328:Adult; D000368:Aged; D003357:Cosmetic Techniques; D005143:Eyelids / Q000187:drug effects*; D005260:Female; D005782:Gels / Q000008:administration & dosage*; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage* / Q000009:adverse effects; D007267:Injections / Q000379:methods; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D012060:Rejuvenation; D012189:Retrospective Studies; D015595:Skin Aging / Q000187:drug effects*; D055815:Young Adult
chemical_list: D005782:Gels; D006820:Hyaluronic Acid