Filling of dark circles under the eyes, “Tear Through” deformity and malar area with fat.

Today we are going to talk about filling dark circles under the eyes and the malar area with fat. This procedure is becoming more and more fashionable every day and it is not for nothing, since it is an excellent treatment to improve the aging of the periorbital area. It must be remembered that it is necessary to make an anatomical study of each patient and a diagnosis prior to the procedure, since it is essential to make a good selection of the patient.

What is the tear through deformity?

One of the most common problems that patients tell us about in the cosmetic surgery office is the presence of dark circles under the eyes, a “tear through” or “tear trough” with a sunken appearance, with a dark coloration of the lower eyelid and resulting in an appearance of tiredness or fatigue (even if the patient has had adequate rest).

This deformity is caused by the anatomical nature of the orbital system, due to the existence of lower eyelid ligaments, attached to the periorbital margin, which remain more or less tense over the years, as opposed to the rest of the eyelid and malar tissues, which become lax and increasingly weaker as we age. In this way, the smooth transition between the lower eyelid structures and the malar area is lost.

What is this procedure looking for?

Restore the natural and aesthetically considered “attractive” shape to the lower eyelid: with a smooth and continuous transition between the preseptal and orbicular portions of the eyelid, with no definite transition point or groove between these areas, and restore the appearance of fullness to the malar prominences.

For which patients is it intended?

Patients of any sex and age who present with tear through deformity, either in the form of sagging or dark coloration of the dark circles under the eyes. The bluish discoloration of dark circles under the eyes is significantly improved with this procedure.

However, patients with large preseptal fat herniation (commonly referred to as “lower eyelid fat pads”), excessive laxity or severe lower eyelid elastosis are not good candidates for this procedure. On the other hand, in cases of skin hyperpigmentation, there may be no improvement in coloration after the procedure.

What types of filling materials are available, and which is the most recommended?

One of the most well-known and widely used filler materials today is hyaluronic acid, a resorbable and biocompatible material (so it will not cause foreign body reactions or rejection) that is used in multiple body areas. It has a resorption rate that varies from 6 months to a year. One of its disadvantages is the high price of the vials of this product, which means that it is preferably applied in areas that require low-volume infiltrations.

Another filler material is the patient’s own adipose tissue, which through a standardized technique is extracted and processed, isolating the adipose cells to later infiltrate them for repair and/or remodeling of certain body areas. The advantages of this type of filler are the following: it is an autologous material (the patient’s own), it is totally biocompatible, safe, and once the graft is stabilized, stable over time. This technique allows us to prepare adipose tissue grafts of large size or volume, so it is generally more economical.

Our choice for the treatment of dark circles under the eyes is the infiltration of adipose tissue grafts, since for an optimal result we normally have to treat two areas: the tear through sagging itself, and the malar area, which will support the lower eyelid in the long term, preventing the deformity from reappearing. This implies that a considerable volume of filler material is used to perform the entire treatment.

However, it is necessary to analyze each case and patient individually.

• For the processing of adipose tissue we use a centrifuge that allows us to isolate adipose tissue from other tissues.