Tear trough treatment with hyaluronic acid

Tear trough treatment with hyaluronic acid is an injectable procedure in which the doctor corrects the hollow beneath the eye, known as the tear trough. With age, and sometimes because of the inherited structure of the face, a depression forms in this area that casts a shadow and gives the eyes a tired appearance, even after a good night's sleep.

Hyaluronic acid is a substance found naturally in the skin. As a gel, injected in small amounts and at the right depth, it gently fills the hollow and smooths the transition between the lower eyelid and the cheek. The procedure is carried out at Detalii Med in Baia Mare by Dr Marius Pruna, Dr Valeria Pruna and Dr Greta Jurj.

The treatment is usually suitable for people who have:

• a visible tear trough that creates a shadow under the eyes;
• a tired-looking gaze despite getting enough rest;
• under-eye skin of reasonable quality, without a large excess of skin;
• realistic expectations of a subtle correction.

The procedure is not recommended during pregnancy or breastfeeding, where there is an active infection or inflammation in the area and, in general, for people with persistent under-eye puffiness. The doctor also discusses other situations at the consultation, such as autoimmune conditions or treatments that increase the risk of bleeding.

Hyaluronic acid can soften the under-eye hollow and the shadow it creates, so that the eyes look more rested. The effect is usually subtle and natural when the amount is right.

However, not all dark circles respond to this treatment. Pigmented dark circles, where the skin itself is darker, are not corrected by filling and may need other dermatological approaches. Large under-eye fat bags or excess skin cannot be resolved with hyaluronic acid; in these cases a surgical solution, such as blepharoplasty, may be more suitable. Dark circles often have several components, and the doctor explains which part can be improved by injection.

The consultation is the most important step, because the under-eye area is delicate and varies greatly from person to person. The doctor examines the skin, the depth of the tear trough, and the presence of fat bags, pigmentation and any swelling. The eyes are assessed under different lighting and from several angles.

Medical history, allergies, current medication, previous injectable treatments and the patient's goals are discussed. If hyaluronic acid is not the right choice, the doctor says so openly and may recommend an alternative. The treatment plan, the estimated amount and the possibility of a touch-up session are agreed at the consultation.

The session usually lasts around 30–45 minutes. The area is carefully cleaned and disinfected, and the doctor marks the treatment points. The gel is injected in small amounts using a fine needle or a cannula, a technique that may reduce the risk of bruising, depending on the case.

The doctor works gradually and checks symmetry along the way, favouring a cautious correction. At the end the area is gently massaged if needed and a cold compress is applied. In some cases a review is scheduled after about two weeks for any fine adjustments.

The procedure is usually performed with an anaesthetic cream applied to the skin a few minutes beforehand. Many hyaluronic acid gels also contain a local anaesthetic, which reduces discomfort during injection. The sensation is usually described as light pressure or a brief sting.

Most patients return to their usual activities the same day or the next. In the first few days there may be mild swelling, redness or small bruises, which usually fade within a few days.

Usual recommendations for the first 24–48 hours:

• avoid strenuous exercise, saunas and exposure to heat;
• avoid massaging or rubbing the area;
• sleep with the head slightly raised;
• apply cold compresses if swelling occurs.

The doctor gives personalised advice and remains available for questions after the procedure.

Like any injectable procedure, tear trough treatment carries risks, and the under-eye area is one of the most sensitive. Possible effects include:

• temporary bruising, redness and swelling;
• prolonged oedema, as this area tends to retain fluid;
• the Tyndall effect, a bluish tint to the skin when the gel lies too superficially;
• irregularities or small lumps;
• rarely, infection or an inflammatory reaction;
• very rarely, vascular complications, which require prompt medical treatment.

One advantage of hyaluronic acid is that it can be dissolved with an enzyme if needed, should the result not be as intended or a complication arise. Any severe pain, change in skin colour or visual disturbance should be reported to the doctor immediately.

Part of the effect is visible straight away, but the result is best judged once the swelling has settled, usually within one to two weeks. The eyes look more rested, with a smoother transition between the eyelid and the cheek.

How long the effect lasts depends on the product, individual metabolism and the area treated. As a guide, under the eyes the effect may last from several months to around a year or longer. The treatment can be repeated, and the timing is agreed with the doctor.

Tear trough treatment with hyaluronic acid can soften the under-eye hollow and a tired-looking gaze, but it only suits certain types of dark circle. A careful assessment, a cautious technique and realistic expectations matter more than the amount of product. At Detalii Med, the doctor decides at the consultation whether injection is appropriate or whether another solution would be more helpful.