Filler-based correction of tear trough depressions and eye bags in Japanese patients: A classification system and treatment algorithm

Abstract

Background: Tear trough depressions are widely treated with fillers. However, it is questionable whether the same strategies can always be used for Caucasian and Japanese patients, owing to differences in bone and skin structures and epithelial thickness. Aims: To assess a novel classification system and treatment algorithm for correcting tear trough depressions and eye bags in Japanese patients. Methods: Tear trough depressions can be classified into three types according to the presence or absence of a “negative vector” based on retrusion of the maxilla relative to the anterior corneal surface, with or without eye-bag protrusion when smiling. Type 1 patients (without the negative vector) can be treated simply by filling the depression in the tear trough and the palpebromalar groove region. Type 2 patients (with a negative vector and no eye-bag protrusion on smiling) also require volume restoration in the mid-cheek (deep medial cheek fat, suborbicularis oculi fat, and pre-maxillary space); this not only enables volume recovery but also compensates for maxillary deficiency. Type 3 patients (with a negative vector and eye-bag protrusion on smiling) require an additional step, based on placing a filler in front of the eye bags and pushing orbital fat backward. Results: Case presentations demonstrate the utility of the techniques involved. Conclusions: This system provides a simple and practical method for classifying and treating Japanese patients with tear trough depressions and eye bags. Further studies are warranted.