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Tear Trough Filler Migration: Achieving Desired Outcomes Safely

Medically Reviewed
Medically Reviewed by Dr. Aurora Kalmanson on
Written by Fillers Editorial Team, plastic surgery specialists.

Tear trough filler migration is a concern for individuals seeking under-eye rejuvenation through dermal fillers. Migration occurs when the filler material moves from the initial injection site, potentially leading to unevenness, swelling, or a distorted appearance.

Factors influencing migration include the injection technique, filler type, and facial movements. Understanding the causes, symptoms, and prevention strategies is crucial for maintaining the desired aesthetic outcome and ensuring patient safety.

Understanding Tear Trough Filler Migration

Tear trough filler migration is a complex issue that can affect the outcomes of cosmetic treatments. It’s essential to seize the underlying causes, prevalence, and contributing factors to effectively manage and prevent this complication.

Definition of Filler Migration

Filler migration refers to the unintended displacement of dermal filler from its original injection site to adjacent areas. This phenomenon can alter the intended aesthetic results, leading to complications such as asymmetry, lumps, and swelling. The migration is influenced by various factors, including the properties of the filler used, the technique of the injector, and the dynamic nature of facial expressions and movements.

Prevalence of Tear Trough Filler Migration

While not a common occurrence, tear trough filler migration is a recognized complication in aesthetic medicine. The prevalence is influenced by several variables, such as the experience level of the injector, the type of filler used, and the anatomical characteristics of the patient. Migration can manifest shortly after the procedure or develop over time, emphasizing the importance of proper technique and follow-up care.

Factors Contributing to Filler Migration

Injection Technique: The method of injecting dermal fillers plays a crucial role in preventing migration. Precise placement and the correct amount of filler are critical to achieving stable and aesthetically pleasing results. Overfilling or incorrect placement can lead to pressure-induced displacement, while the natural movements of facial muscles can also contribute to the gradual shifting of the filler.

Filler Type and Properties: The characteristics of the filler material, such as its viscosity and cohesivity, significantly impact the likelihood of migration. Fillers with higher viscosity and cohesivity are less prone to movement, making them more suitable for the delicate and dynamic tear trough area. Selecting the right type of filler is a crucial decision that should be tailored to the individual’s needs and the specificities of the treatment area.

Anatomical Considerations: The unique anatomy of the tear trough region plays a significant role in the risk of filler migration. The area is characterized by thin overlying skin, a lack of supportive fat, and the presence of the orbicularis oculi muscle, which can influence the behavior of injected fillers. Additionally, the underlying bony structure and the proximity to the orbital septum necessitate a thorough understanding of facial anatomy to avoid complications. An injector’s knowledge of these anatomical nuances is crucial for precise filler placement and to minimize the risk of migration.

Causes of Tear Trough Filler Migration

Identifying the root causes of tear trough filler migration is essential for prevention and management. Key factors include overfilling, incorrect placement, and the anatomical structure of the treatment area.

Overfilling of the Treatment Area

Overfilling the tear trough area with dermal filler is a primary cause of migration. The delicate and confined space under the eyes can only accommodate a limited volume of filler. Exceeding this capacity creates excessive pressure, prompting the filler to move towards areas with less resistance. This can lead to unnatural bulging, puffiness, and the displacement of the filler from the original treatment zone. A conservative approach, with the option of gradual touch-ups, is recommended to achieve a balanced and natural-looking result.

Incorrect Placement of Filler

Superficial Injection

Superficial Injection: Injecting filler too close to the skin surface in the tear trough area can lead to visible irregularities, including the Tyndall effect, where the skin takes on a bluish hue due to the light-reflecting properties of the filler. Superficial placement can also result in lumps that are noticeable when the skin is moved or when facial expressions change. To avoid these issues, fillers should be injected at the appropriate depth, where they can provide volume without affecting the surface texture and color of the skin.

Injection Too Close to the Orbital Rim

Injection Too Close to the Orbital Rim: The proximity of injections to the orbital rim is a critical factor in preventing filler migration. When filler is placed too close to this bony edge, there is an increased risk of the product migrating into the lower eyelid, causing puffiness and an unnatural contour. Proper injection technique involves placing the filler deep enough and at a safe distance from the orbital rim to ensure it remains in the intended area, providing a smooth transition from the lower eyelid to the cheek.

Treatment Options for Migrated Tear Trough Filler

A range of treatment options is available for managing migrated tear trough filler, adapted to the type of filler used and the specific complications encountered.

Hyaluronidase Injections for Hyaluronic Acid Fillers

Mechanism of Action: Hyaluronidase is an enzyme that catalyzes the breakdown of hyaluronic acid, the most commonly used substance in tear trough fillers. When injected into areas where filler has migrated, hyaluronidase rapidly dissolves the hyaluronic acid, allowing the body to absorb and eliminate it. This process effectively reverses the effects of the filler, addressing issues such as lumps, asymmetry, and the Tyndall effect. The enzyme’s ability to target hyaluronic acid specifically makes it an invaluable tool for correcting filler migration.

Surgical Removal for Non-Hyaluronic Acid Fillers

Indications and Considerations: Surgical removal is considered for migrated fillers that cannot be dissolved by hyaluronidase, such as those made from calcium hydroxylapatite or poly-L-lactic acid. Indications for surgery include significant migration causing aesthetic or functional damage, the presence of granulomas, or when other treatments have failed. Surgical considerations involve the risks of anesthesia, potential scarring, and the need for a skilled surgeon familiar with facial anatomy. The decision for surgery is made after a thorough evaluation of the risks and benefits, and it is often seen as a last resort.

Frequently Asked Questions

How common is tear trough filler migration?

Tear trough filler migration is relatively uncommon when performed by experienced practitioners using appropriate techniques and materials.

Can tear trough filler migrate years after treatment?

Yes, tear trough filler can migrate years after treatment, although this is less common and often associated with certain types of fillers or injection techniques.

Is tear trough filler migration reversible?

Yes, tear trough filler migration is often reversible, especially if the filler is based on hyaluronic acid, which can be dissolved with hyaluronidase.

How can I tell if my tear trough filler has migrated?

Signs of tear trough filler migration include visible lumps, asymmetry, swelling, or changes in the under-eye contour.

Can massaging the area help with migrated tear trough filler?

Massaging may help with minor cases of migration, but it should be done under professional guidance to avoid further displacement.

How long does it take for migrated tear trough filler to resolve?

The time it takes for migrated tear trough filler to resolve depends on the treatment approach, but hyaluronidase can reverse hyaluronic acid filler effects within days.

Is it safe to have tear trough filler treatment after experiencing migration?

It is generally safe to have tear trough filler treatment after experiencing migration, provided the underlying cause has been addressed and corrected.

Conclusion

In conclusion, while tear trough filler migration is not a frequent occurrence, it is a potential risk that requires attention. The key to successful treatment lies in the expertise of the injector, the choice of appropriate filler, and adherence to proper aftercare. Should migration occur, there are effective treatments available to correct it. As with any cosmetic procedure, patient education and realistic expectations are essential for achieving satisfactory results.

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References:

Urdiales-Gálvez, F., & Farollch-Prats, L. (2021). Management of Tear Trough with Hyaluronic Acid Fillers: A Clinical-Practice Dual Approach

https://www.dovepress.com/management-of-tear-trough-with-hyaluronic-acid-fillers-a-clinical-prac-peer-reviewed-fulltext-article-CCID

Jordan, D. R., & Stoica, B. (2015). Filler Migration: A Number of Mechanisms to Consider.

https://journals.lww.com/op-rs/abstract/2015/07000/filler_migration__a_number_of_mechanisms_to.1.aspx

Diwan, Z., Trikha, S., Etemad-Shahidi, S., Alli, Z., Rennie, C., & Penny, A. (2020). A Prospective Study on Safety, Complications and Satisfaction Analysis for Tear Trough Rejuvenation Using Hyaluronic Acid Dermal Fillers.

https://journals.lww.com/prsgo/fulltext/2020/04000/a_prospective_study_on_safety,_complications_and.6.aspx

Dr. Aurora Kalmanson

Always Consult a Medical Specialist

The information provided in this blog is for informational and educational purposes only and should not be interpreted as personalized medical advice. It's crucial to understand that while we are medical professionals, the insights and advice we provide are based on general research and studies. They are not tailored to individual health needs or conditions. Thus, it is essential to consult directly with a healthcare provider who can offer personalized medical advice relevant to your specific situation.