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

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.

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.