Abstract
Background
Hyaluronic acid (HA) injection is an effective method to correct tear trough deformity. Nevertheless, the quantitative data of cosmetic results and complications of HA injection in tear troughs remained unemployed. The purpose of this meta-analysis was to synthesize the current quantitative data on the aesthetic outcomes and adverse effects of tear trough deformity correction with HA injection.
Methods
This meta-analysis consulted PubMed, Embase, Web of Science, Scopus and Cochrane databases based on the search terms published before September 2022. Data extracted was analyzed to evaluate the satisfaction rates and complications of HA injection. Meta-analysis was performed using the random-effect model for overall and subgroup analysis.
Results
This meta-analysis comprised 31 reports involving 2556 participants. The pooled overall satisfaction rate was 91.0% (95% CI 84.9–95.7%). The pooled rates of swelling/edema and bruising/ecchymosis were 19.2% (95% CI 10.4–29.9%) and 18.4% (95% CI 10.1–28.4%), respectively. The pooled rates of redness/erythema, contour irregularity/lump and blue discoloration/Tyndall effect were 7.1% (95% CI 1.5–15.6%), 5.3% (95% CI 1.8–10.2%) and 0.9% (95% CI 0.0–2.5%), respectively.
Conclusions
The present meta-analysis manifested a low risk of complication rate and a high satisfaction rate in tear trough rejuvenation with HA injection.
Level of Evidence I
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Similar content being viewed by others
Reference
Kane MAC (2015) Nonsurgical periorbital and brow rejuvenation. Plast Reconstr Surg 135(1):63–71
Haddock NT, Saadeh PB, Boutros S, Thorne CH (2009) The tear trough and lid/cheek junction: anatomy and implications for surgical correction. Plast Reconstr Surg 123(4):1332–1340
Borba A, Rodrigues M (2021) Periorbital filling with the MD Codes™ algorithm: a narrative review and a practical guide. J Cosmet Dermatol 20(11):3398–3406
Wong CH, Hsieh MKH, Mendelson B (2012) The tear trough ligament: anatomical basis for the tear trough deformity. Plast Reconstr Surg 129(6):1392–1402
Innocenti A, Melita D, Ghezzi S, Innocenti M (2018) Refinements in tear trough deformity correction: intraoral release of tear trough ligaments: anatomical consideration and clinical approach. Aesthetic Plast Surg 42(6):1576–1581
Yang C, Zhang P, Xing X (2013) Tear trough and palpebromalar groove in young versus elderly adults: a sectional anatomy study. Plast Reconstr Surg 132(4):796–808
Aniagwu U (2022) Recognising the key tear trough ligaments: Dr Uche Aniagwu details the anatomy of the ligaments in the under-eye region. Plast Aesthet Nurs (Phila). 42(1):46–47
Mojallal A, Cotofana S (2017) Anatomy of lower eyelid and eyelid-cheek junction. Ann Chir Plast Esthet 62(5):365–374
Anido J, Fernández JM, Genol I, Ribé N, Pérez Sevilla G (2021) Recommendations for the treatment of tear trough deformity with cross-linked hyaluronic acid filler. J Cosmet Dermatol 20(1):6–17
Chiu C-Y, Shen Y-C, Zhao Q-F, Hong F-L, Xu J-H (2017) Treatment of tear trough deformity: fat repositioning versus autologous fat grafting. Aesthetic Plast Surg 41(1):73–80
Goldberg DJ (2009) Correction of tear trough deformity with novel porcine collagen dermal filler (Dermicol-P35). Aesthet Surg J 29(3 Suppl):S9-s11
Diaspro A, Calvisi L, Sito G (2022) Hyaluronic acid gel injection for the treatment of tear trough deformity: a multicenter, observational, Single-Blind Study. Aesthetic Plastic Surg 46(4):1860–1867
Lin JY, Lin CY (2022) Nonsurgical lower eyelid rejuvenation using injectable poly-d, l-lactic acid in Asian patients. J Cosmet Dermatol 21(10):4328–4331
Corduff N (2020) An alternative periorbital treatment option using calcium hydroxyapatite for hyperpigmentation associated with the tear trough deformity. Plast Reconstr Surg Glob Open 8(2):e2633
Trinh LN, Grond SE, Gupta A (2022) Dermal fillers for tear trough rejuvenation: a systematic review. Facial Plast Surg 38(03):228–239
Gorbea E, Kidwai S, Rosenberg J (2021) Nonsurgical tear trough volumization: a systematic review of patient satisfaction. Aesthet Surg J. 41(8):NP1053-NP1060
Rao BK, Berger LE, Reilly C, Alamgir M, Galadari H (2022) Tear trough filler techniques utilizing hyaluronic acid: a systematic review. Plast Reconstr Surg 149(5):1079–1087
Trinh LN, McGuigan KC, Gupta A (2022) Delayed complications following dermal filler for tear trough augmentation: a systematic review. Facial Plast Surg 38(3):250–259
Stewart LA, Clarke M, Rovers M, Riley RD, Simmonds M, Stewart G et al (2015) Preferred reporting items for systematic review and meta-analyses of individual participant data: the PRISMA-IPD Statement. J Am Med Assoc 313(16):1657–1665
Sundaram H, Cassuto D (2013) Biophysical characteristics of hyaluronic acid soft-tissue fillers and their relevance to aesthetic applications. Plast Reconstr Surg 132(4 Suppl 2):5S-21S
Edsman KLM, Ohrlund A (2018) Cohesion of hyaluronic acid fillers: correlation between cohesion and other physicochemical properties. Dermatol Surg 44(4):557–562
de la Guardia C, Virno A, Musumeci M, Bernardin A, Silberberg MB (2022) Rheologic and physicochemical characteristics of hyaluronic acid fillers: overview and relationship to product performance. Facial Plast Surg 38(2):116–123
Nanda S, Bansal S, Lakhani R (2021) Use of Hyaluronic acid fillers in treatment of periorbital melanosis induced by tear trough deformity: anatomical considerations, patient satisfaction, and management of complications. J Cosmet Dermatol 20(10):3181–3189
Morley AM, Malhotra R (2011) Use of hyaluronic acid filler for tear-trough rejuvenation as an alternative to lower eyelid surgery. Ophthalmic Plast Reconstr Surg 27(2):69–73
Viana GAP, Osaki MH, Cariello AJ, Damasceno RW (2011) Treatment of tear trough deformity with hyaluronic acid gel filler. Arq Bras Oftalmol 74(1):44–47
Kane MA (2005) Treatment of tear trough deformity and lower lid bowing with injectable hyaluronic acid. Aesthetic Plast Surg 29(5):363–367
Hussain SN, Mangal S, Goodman GJ (2019) The Tick technique: a method to simplify and quantify treatment of the tear trough region. J Cosmet Dermatol 18(6):1642–1647
Berguiga M, Galatoire O (2017) Tear trough rejuvenation: a safety evaluation of the treatment by a semi-cross-linked hyaluronic acid filler. Orbit 36(1):22–26
Pascali M, Quarato D, Pagnoni M, Carinci F (2017) Tear trough deformity: study of filling procedures for its correction. J Craniofac Surg 28(8):2012–2015
Jiang J, Wang X, Chen R, Xia X, Sun S, Hu K (2016) Tear trough deformity: different types of anatomy and treatment options. Postepy Dermatologii i Alergologii. 33(4):303–308
Bernardini FP, Casabona G, Alfertshofer MG, Frank K, Moellhoff N, Gotkin RH et al (2021) Soft tissue filler augmentation of the orbicularis retaining ligament to improve the lid-cheek junction. J Cosmet Dermatol 20(11):3446–3453
Hevia O, Cohen BH, Howell DJ (2014) Safety and efficacy of a cohesive polydensified matrix hyaluronic acid for the correction of infraorbital hollow: an observational study with results at 40 weeks. J Drugs Dermatol 13(9):1030–1036
Donath AS, Glasgold RA, Meier J, Glasgold MJ (2010) Quantitative evaluation of volume augmentation in the tear trough with a hyaluronic acid-based filler: a three-dimensional analysis. Plast Reconstr Surg 125(5):1515–1522
Niforos F, Acquilla R, Ogilvie P, Safa M, Signorini M, Creutz L et al (2017) A prospective, open-label study of hyaluronic acid-based filler with lidocaine (VYC-15L) treatment for the correction of infraorbital skin depressions. Dermatol Surg 43(10):1271–1280
Fabi S, Zoumalan C, Fagien S, Yoelin S, Sartor M, Chawla S (2021) A prospective, multicenter, single-blind, randomized, controlled study of VYC-15L, a hyaluronic acid filler, in adults for correction of infraorbital hollowing. Aesthet Surg J 41(11):NP1675-NP1685
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. Plast Reconstr Surg Glob Open 8(4):e2753
Hall MB, Roy S, Buckingham ED (2018) Novel use of a volumizing hyaluronic acid filler for treatment of infraorbital hollows. JAMA Facial Plast Surg. 20(5):367–372
Shah-Desai S, Joganathan V (2021) Novel technique of non-surgical rejuvenation of infraorbital dark circles. J Cosmet Dermatol 20(4):1214–1220
Vadera S, Shome D, Kumar V, Doshi K, Kapoor R (2021) Innovative approach for tear trough deformity correction using higher G prime fillers for safe, efficacious, and long-lasting results: a prospective interventional study. J Cosmet Dermatol 20(10):3147–3154
Wollina U (2014) Improvement of tear trough by monophasic hyaluronic acid and calcium hydroxylapatite. J Clin Aesthetic Dermatol 7(10):38–43
Berros P, Lax L, Bétis F (2013) Hyalurostructure treatment: superior clinical outcome through a new protocol-a 4-year comparative study of two methods for tear trough treatment. Plast Reconstr Surg 132(6):924e-e931
Berros P (2010) Periorbital contour abnormalities: hollow eye ring management with hyalurostructure. Orbit 29(2):119–125
Bosniak S, Sadick NS, Cantisano-Zilkha M, Glavas IP, Roy D (2008) The hyaluronic acid push technique for the nasojugal groove. Dermatol Surg 34(1):127–131
De Pasquale A, Russa G, Pulvirenti M, Di Rosa L (2013) Hyaluronic acid filler injections for tear-trough deformity: injection technique and high-frequency ultrasound follow-up evaluation. Aesthetic Plast Surg 37(3):587–591
Mustak H, Fiaschetti D, Goldberg RA (2018) Filling the periorbital hollows with hyaluronic acid gel: long-term review of outcomes and complications. J Cosmet Dermatol 17(4):611–616
El-Garem YF (2015) Estimation of bony orbit depth for optimal selection of the injection technique to correct the tear trough and palpebromalar groove. Dermatol Surg 41(1):94–101
Steinsapir KD, Steinsapir SM (2006) Deep-fill hyaluronic acid for the temporary treatment of the naso-jugal groove: a report of 303 consecutive treatments. Ophthalmic Plast Reconstr Surg 22(5):344–348
Rzany B, Cartier H, Kestermont P, Trevidic P, Sattler G, Kerrouche N et al (2012) Correction of tear troughs and periorbital lines with a range of customized hyaluronic acid fillers. J Drugs Dermatol 11(1 Suppl):s27-34
Wollina U, Goldman A (2021) Correction of tear trough deformity by hyaluronic acid soft tissue filler placement inferior to the lateral orbital thickening. Dermatol Ther 34(5):e15045
Hamman MS, Goldman MP, Fabi SG (2012) Comparison of two techniques using hyaluronic acid to correct the tear trough deformity. J Drugs Dermatol 11(12):e80–e84
Tung R, Ruiz de Luzuriaga AM, Park K, Sato M, Dubina M, Alam M (2012) Brighter eyes: combined upper cheek and tear trough augmentation: a systematic approach utilizing two complementary hyaluronic acid fillers. J Drugs Dermatol 11(9):1094–1097
Nikolis A, Berros P, Enright KM, Cordoba M, Nguyen Q (2022) A randomized, crossover-controlled evaluator-blinded trial evaluating cannula- vs needle-assisted hyaluronic acid injections for infraorbital deformities. Aesthet Surg J 42(3):285–297
Viana GA, Osaki MH, Cariello AJ, Damasceno RW, Osaki TH (2011) Treatment of the tear trough deformity with hyaluronic acid. Aesthet Surg J 31(2):225–231
Doi SA, Xu C (2021) The Freeman-Tukey double arcsine transformation for the meta-analysis of proportions: recent criticisms were seriously misleading. J Evid Based Med 14(4):259–261
(2020) The Aesthetic Society's Cosmetic Surgery National Data Bank: Statistics 2019. Aesthet Surg J 40(Suppl 1):1–26
Cox SE (2009) Clinical experience with filler complications. Dermatol Surg 35(Suppl 2):1661–1666
Fagien S, Bertucci V, von Grote E, Mashburn JH (2019) Rheologic and physicochemical properties used to differentiate injectable hyaluronic acid filler products. Plast Reconstr Surg 143(4):707e-e720
Lee W, Hwang SG, Oh W, Kim CY, Lee JL, Yang EJ (2020) Practical guidelines for hyaluronic acid soft-tissue filler use in facial rejuvenation. Dermatol Surg 46(1):41–49
Hirmand H (2010) Anatomy and nonsurgical correction of the tear trough deformity. Plast Reconstr Surg 125(2):699–708
van Loghem JAJ, Humzah D, Kerscher M (2017) Cannula versus sharp needle for placement of soft tissue fillers: an observational cadaver study. Aesthet Surg J 38(1):73–88
Wu W, Carlisle I, Huang P, Ribe N, Russo R, Schaar C et al (2010) Novel administration technique for large-particle stabilized hyaluronic acid-based gel of nonanimal origin in facial tissue augmentation. Aesthetic Plast Surg 34(1):88–95
Cotofana S, Gotkin RH, Frank K, Lachman N, Schenck TL (2020) Anatomy behind the facial overfilled syndrome: the transverse facial septum. Dermatol Surg 46(8):e16–e22
Cao L, Zhu F (2021) Comparison of tumescent local anesthesia vs normal anesthesia technology in upper blepharoplasty in Asian women. J Cosmet Dermatol 20(7):2264–9
Haggard P, de Boer L (2014) Oral somatosensory awareness. Neurosci Biobehav Rev 47:469–484
Kumar M, Chawla R, Goyal M (2015) Topical anesthesia. J Anaesthesiol Clin Pharmacol 31(4):450–456
Goldberg RA, Fiaschetti D (2006) Filling the periorbital hollows with hyaluronic acid gel: initial experience with 244 injections. Ophthalmic Plast Reconstr Surg. 22(5):335–341; discussion 341-3
Airan LE, Born TM (2005) Nonsurgical lower eyelid lift. Plast Reconstr Surg 116(6):1785–1792
Rafailov L, Kulak A, Weedon J, Shinder R (2015) Comparison of lidocaine gel-assisted transconjunctival and transcutaneous local anesthesia for outpatient eyelid surgery. Ophthalmic Plast Reconstr Surg 31(6):470–473
Skippen B, Baldelli I, Hartstein M, Casabona G, Montes JR, Bernardini F (2020) Rehabilitation of the dysmorphic lower eyelid from hyaluronic acid filler: what to do after a good periocular treatment goes bad. Aesthet Surg J 40(2):197–205
Dubinsky-Pertzov B, Bernardini FP, Or L, Gazit I, Hartstein ME (2021) Late-onset upper eyelid and brow edema as a long-term complication of hyaluronic acid filler injection. Aesthet Surg J 41(6):NP464-NP471
Artzi O, Loizides C, Verner I, Landau M (2016) Resistant and recurrent late reaction to hyaluronic acid-based gel. Dermatol Surg 42(1):31–37
Cotofana S, Schenck TL, Trevidic P, Sykes J, Massry GG, Liew S et al (2015) Midface: clinical anatomy and regional approaches with injectable fillers. Plast Reconstr Surg 136(5 Suppl):219S-S234
Noell CM, Weiss RA (2021) Handheld doppler localization of the angular artery to reduce intravascular injection in tear trough rejuvenation. Dermatol Surg 47(8):1171–1173
Jitaree B, Phumyoo T, Uruwan S, Sawatwong W, McCormick L, Tansatit T (2018) The feasibility determination of risky severe complications of arterial vasculature regarding the filler injection sites at the tear trough. Plast Reconstr Surg 142(5):1153–1163
Wollina U, Goldman A (2020) Facial vascular danger zones for filler injections. Dermatol Ther 33(6):e14285
Zhang LX, Lai LY, Zhou GW, Liang LM, Zhou YC, Bai XY et al (2020) Evaluation of intraarterial thrombolysis in treatment of cosmetic facial filler-related ophthalmic artery occlusion. Plast Reconstr Surg 145(1):42e–50e
Kim Y-S, Choi D-Y, Gil Y-C, Hu K-S, Tansatit T, Kim H-J (2014) The anatomical origin and course of the angular artery regarding its clinical implications. Dermatol Surg 40(10):1070–1076
Chen S, Ma H, Song T, Li H, Wu D, Wang Y et al (2022) Anatomical characterization of the tear trough and the lid-cheek junction: an iodine staining technique based on high-resolution micro-computed tomography. Plast Reconstr Surg 149(4):646e-e654
Matarasso SL, Carruthers JD, Jewell ML, Restylane Consensus G (2006) Consensus recommendations for soft-tissue augmentation with nonanimal stabilized hyaluronic acid (Restylane). Plast Reconstr Surg 117(3 Suppl):3S-34S
Acknowledgements
The authors declare that they have no conflicts of interest to disclose.
Funding
None.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors state no conflict of interest.
Human and Animal Rights
This article does not contain any studies with human participants or animals performed by any of the authors.
Informed Consent
For this type of study, informed consent is not required.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Liu, X., Gao, Y., Ma, J. et al. The Efficacy and Safety of Hyaluronic Acid Injection in Tear Trough Deformity: A Systematic Review and Meta-analysis. Aesth Plast Surg 48, 478–490 (2024). https://doi.org/10.1007/s00266-023-03613-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00266-023-03613-7