Tear Trough Filler Using the Three-point Tangent Technique: Lessons from 1452 Tear Trough Applications

This study describes a novel three-point tangent technique for tear trough filler and the results from the largest series to date. METHODS: A retrospective case review was performed for all patients treated between 2016 and 2020. Patient demographics, filler details and complications were recorded. The injection technique involves using a blunt cannula to deliver filler along three linear tangents bespoke to each patient. RESULTS: A total of 1452 applications of filler to the orbits of 583 patients were recorded. The median patient age was 41 years (range 19–77), and 84% were women. The mean volume of applied filler at the first appointment was 0.34 mL to each orbit (range 0.1–-1.5); 82% reported no complication, 10% reported swelling with a median duration of 4 weeks (range 1–52), 4.3% experienced bruising, 4.6% reported contour irregularities, and 3.3% experienced a Tyndall effect. Retrobulbar hemorrhage occurred in one patient (0.17%), which was managed immediately with no lasting visual compromise. Volume of filler injected was significantly associated with a risk of edema (P < 0.00001) and contour irregularities (P = 0.012). In total, 50% of cases of edema resolved spontaneously after 4 weeks. Filler was dissolved in 1.9% of orbits. Patients with a history of dissolving were significantly more likely to require dissolving after subsequent reinjection (P = 0.043). CONCLUSIONS: The three-point tangent technique is a safe and effective method. Increasing volume of filler administered is associated with complications of edema and contour irregularities. Edema is the most common complication and resolves spontaneously in half of patients by 4 weeks.