Treating The Tear Troughs Via The Cheek

Tear trough filler is an advanced aesthetics treatment that new injectors should not attempt without proper training. However, once you are confident in your injecting skills, especially using a cannula, often you will be able to start indirectly treating the tear troughs via the cheek.

Though still a tricky and demanding treatment, this approach to the under eyes is less risky than treating the tear troughs directly and can produce lovely results. In some cases this may mean the tear trough does not need direct treatment.

Therefore, it’s a good intermediate step for new injectors. One for those who have gained confidence in treating patients with fundamental dermal filler and toxin treatments, but who are not yet ready for advanced aesthetic medicine training.

Patients love the refreshed look it gives to their appearance, making them look instantly more awake and less tired, too. They are also rewarding treatments to deliver!

Midface filler for indirect tear trough treatment

Dr Raquel Amado is a senior clinical trainer at Harley Academy. She is also an experienced facial aesthetics and skin ageing specialist who runs her own successful practice in Kent. She talked us through the technique for treating the tear troughs via the cheek…

How do you treat the tear troughs via the cheek?

“You treat the cheek apex, the lateral zygoma and the medial cheek fat that supports the tear trough region. It’s called a midface treatment.”

It's worth noting that any cheek filler will have an effect on hollowing and you should bear this in mind when planning your treatment.

Who is this type of under eye filler treatment suitable for?

“Tear trough treatment is not suitable for patients who have malar mounds, anyone who has periorbital oedema, swelling, any bags under the eyes or excessive skin laxity. Obviously it all depends on the individual patient. Always conduct a thorough consultation prior to treatment. This includes discussing realistic expectations and alternative treatments as appropriate.”

What is the correct injection technique for treating tear troughs via the midface?

“When you treat the tear trough via a mid-face treatment, you’re injecting into layer four below the muscle," advises Dr Raquel.

"If you’re doing lateral zygoma, you can use superperiosteal boluses or you can go into the prezygomatic space with a cannula.

"Medial fat restoration is always layer four with a cannula to avoid damage to the infraorbital neurovasculature. Use linear threads or a fanning technique.”

You can learn more about this, including anatomical considerations, product recommendations, needle placement and more, via explanations, video demonstrations and 3D illustrations, in the GEM© by Harley Academy app. This Global Evidence Matrix app is available for healthcare professionals working as aesthetic practitioners to purchase via annual subscription. It's also provided to trainees taking any of our Level 7 Diploma in Cosmetic Injectables courses free of charge for 12 months.

How can injectors learn this technique?

“Midface treatments can be covered to a certain extent during the mentoring of your Level 7 Diploma in Botox & Dermal Fillers course. This would include the basic techniques. Dedicated, in-depth training on under-eye filler treatments are available during our Tear Trough Filler Masterclass course.”

For specific indirect tear trough filler training, where you're essentially administering a mid-face filler treatment, another Injectables Masterclass may be best. Our Facial Contouring Masterclass offers specialist aesthetics training in these popular areas. It covers various aspects of the mid-face and lower face for proportionate outcomes.

In addition to learning new techniques, you'll also find out how to combine treatments for more holistic, natural-looking, full-face rejuvenation results.

What other options are there for treating under eye hollowing?

Treating under-eye hollows doesn’t always require indirect filler via the cheek. There's direct tear trough filler, of course, but some patients can be reticent about having filler in this region. In these instances, there are alternative options that you can try.

Many patients who present with under-eye 'hollows' may not need volume. Support, texture improvements and/or pigment control may be more appropriate. A tailored, multi-modal approach that considers the skin, structure, and shadowing is often the most natural-looking and sustainable.

The suitability and success of any treatment will be dependent on the cause of their hollowing and appropriate patient selection.

Always manage your patients' expectations appropriately as, especially where they wish to have significant hollowing without filler, there's a level to what can be achieved. Being open about this ahead of time allows them to provide informed consent if they do decide to proceed with treatment.

3 tear trough treatments that don't require filler

• Where there are early signs of fatigue but no deep volume loss, you may wish to consider periocular polynucleotides
• Microneedling, which can be paired with skin boosters, is a useful skin treatment where there's thin, crepey skin as this can improve collagen density
• A dedicated topical retinoid suitable for use around the eyes can help to stimulate collagen and improve skin density. Again, this is best suited to those without significant hollowing.

Find out more about midface filler courses

If you are a doctor, dentist, nurse or clinical pharmacist and have a particular aesthetic treatment or competency you’d like to learn or improve, we can help. In addition to the injectables course information on our website, you can book a call with our support consultants to learn more. 

They know our courses inside out and will be able to guide you through your options to find the perfect fit. Whether you’re starting from scratch or are a more experienced medical aesthetics practitioner looking to hone your skills in a specific area, they'll set out your best matches.

They can also advise you on our full offering of aesthetic courses and the payment options available for future-proofing your career by becoming #HarleyTrained.

All information correct at the time of publication