Why don’t more doctors practice ligament release with a blunt tipped cannula for treatment of tear troughs?

Question

I’ve read a few medical articles about this new approach to treating this area. I’ve had initial success with dermal fillers, but after a few years the filler starts to migrate and get old, and I get a slight Tyndall affect, that previously wasn’t there. It seems like the release of the ligament in the tear trough greatly improves the problem without (or at least with a whole lot less of) an HA filler. Will more doctors start to practice this soon?

Leonard Grossman, MD · Answer

First of all, there is no ligament that is creating the tear trough deformity. Secondly, in my opinion, hyaluronic acid fillers, should not be used in the tear trough. The reasons for that: number one, the skin in the lower eyelid is extremely and transillumination of an aggregate of hyaluronic acid creates the Tyndall effect. Reason number two, the eye is surrounded by a muscle called orbicularis oculi muscle, which acts like a sphincter and constantly squeezes around the eye, while protecting it.  That action pushes the gelatinous form of hyaluronic acid towards a portion of the eye, where there is no muscle, and that portion is close to the nose.  This sphincter like action, causes an accumulation of hyaluronic acid filler, creating a blob like effect. In my opinion, the best product to be used for tear trough deformity correction is the patient’s on fat. Fat transfer when performed by a plastic surgeon with a great deal of experience in fat, transfer techniques, produces natural and permanent results. I hope this helps and good luck from New York City Plastic Surgery.

Robert T. Buchanan, MD (retired) · Answer

What is old is new again. Facial ligament release is an old therapy for nasolabial folds and other areas. Almost no one does it any more because it doesn’t last. The  resultant scar just reattaches the ligament to the skin even if you try to put something between them. We have, instead, started treating the cause instead by filling the tissues where volume loss has caused the problem. The same is true of the tear trough. The problem is loss of volume below the ligament, so treatment by experts is to fill below the ligament. This does not migrate or cause a Tindall effect. We also tried ligament release with Blepharoplasty and most have abandoned that also. Those using ligament release just don’t understand the anatomy or the history of treatment of the area.

Why don’t more doctors practice ligament release with a blunt tipped cannula for treatment of tear troughs?

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Why don’t more doctors practice ligament release with a blunt tipped cannula for treatment of tear troughs?

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Everything you need to know about Dermal Fillers

Our mission is to create a world where every investment in modern beauty is Worth It.