Tear trough fillers using a cannula

Histological changes in skin and its underlying structures result in different facial aging signs. Even though these signs are inevitable; some people show them earlier than others due to other contributing factors such as lifestyle, diet, comorbidities, etc.

Our practice showed that under-eye and tear trough issues are of the most common cosmetic concerns of facial aging in both males and females. The reason for under eye wrinkles and bags is the resorption fat in the periocular areas. The uneven light reflection, caused by the fat atrophy, results in a darker shade of color, which exaggerates the cosmetic concern.

Since the under-eye bags are due to the loss of fat pad in the area, therefore, dermal fillers under the eyes and in the tear trough area result in partial restoration of the fullness and alleviate the concern. The procedure is considered a good alternative for the invasive lower blepharoplasty.

Case 1037 Under eye fillers

The client is female in her mid-50s, we took a full medical history and has not contraindication for fillers. Her main concern is the tired look due to under eye bags

The procedure

We used 0.5 ml of low cross-linked 20mg/ml hyaluronic acid on each side. To pinpoint the entry, we relied on the crossing between the lateral limbus vertical line and the ala-tragus horizontal line. To proceed with filler implementation, we used a 22G hypodermic needle to puncture the epiderm and inserted a 25G blunt cannula directly. Dr. Alhallak (Ph.D.) directed the cannula to the tear trough area and placed the fillers in different layers by rotating the tip of the cannula. With the tip pointed up, we were able to place the HA filler more superficial. Since HA fillers are highly hydrophilic, we recommend using a low cross-linked filler and aim for a slight under-correction to allow of some water absorption.


The procedure made the clients look overall refreshed due to the fat volume restoration of the ogee curve, which resulted in even light. The results typically last 8-12 months.

under eye fillers
under eye fillers

Acknowledgments: Albany Cosmetic and Laser Center team led by Dr. Kamal Alhallak (Ph.D.)

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