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Hyalurostructure Treatment: Superior Clinical Outcome through a New Protocol—A 4-Year Comparative Study of Two Methods for Tear Trough Treatment

Berros, Philippe M.D.; Lax, Lilian M.D.; Bétis, Frédéric Ph.D.

Plastic and Reconstructive Surgery: December 2013 - Volume 132 - Issue 6 - p 924e–931e
doi: 10.1097/PRS.0b013e3182a80683
Cosmetic: Original Article
Best Paper

Background: The tear trough represents a main aesthetic characteristic of the aging process, which leads many patients to the wish for a safe and efficient rejuvenation method to fill their eye rings. The authors analyzed results and complication rates of two methods for hollow eye ring treatment.

Methods: The authors used two methods on two patient collectives. Group A was treated using hyaluronic acid gel (Restylane; Q-Med, Uppsala, Sweden) and a reinforced 25-gauge Pix’l+ micro cannula. The authors developed a modified method for group B that included a combination of cooling of the periorbital area, no local anesthesia, preincision displacement of malar fat 10 mm below the orbital border, and postintervention corticoid therapy for 48 hours.

Results: Protocol B was associated with significantly lower complication rates. The authors also analyzed in how smoking, age, and skin properties might affect the clinical outcome. They found that choice of treatment and a history of blepharoplasty were significant predictive factors that correlated with complications.

Conclusions: Tear trough treatment by hyalurostructure shows satisfying and efficient results with few complications. The revised technique used in group B combines multiple peri-interventional procedures including preinjection cooling of the periorbital area, preincision with displacement of the malar fat 10 mm below the orbital border, applying gentle back-and-forth movements while injecting, and oral corticosteroid therapy 48 hours after intervention. This technique makes hyalurostructure a competent and promising treatment for tear trough management.


Monte Carlo, Monaco; and Heidelberg, Germany

From the Department of Ophthalmology and Oculoplasty, Princess Grace Hospital, and Alcazar Eye Clinic.

Received for publication April 5, 2013; accepted June 3, 2013.

Disclosure: Dr. Berros is a medical consultant for Galderma Q-Med. The other authors have no financial interests to declare.

Philippe Berros, M.D., Department of Ophthalmology and Oculoplasty, Princess Grace Hospital, Avenue Pasteur 98000, Monte Carlo, Monaco,

©2013American Society of Plastic Surgeons