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Patient selection for “tear trough” dermal filler injections require additional training and carry risk of complications and adverse effects. Due to the nature of the “tear trough” procedure there are a number of considerations that need to be addressed even before performing the procedure: Patient skin laxity - excessive skin or laxity of skin will not respond positively to a “tear trough” filler injection - it will not be aesthetically pleasing Patient skin transparency - this is the major complication associated with “tear trough” filler injections - the dermal filler product would cause “tyndall effect” under the eye Location of Depression - dermal filler injections cannot be placed above the orbital rim, dependent upon the indication they may not be a candidate for the procedure Dark Circles - though “tear trough” injections may help it also needs to be understood that these dark circles are vascular in nature and the injection will have increased risk. Typically, the older the patient the less likely the effect will be aesthetically pleasing but there are exceptions to every “rule of thumb”. The smaller the depression the greater chance of giving correction using dermal fillers. The larger the depression will give only partial correction for the patient - this is why we spend a large time allotment to this procedure within our training courses as to patient selection and we do not publish videos on the matter. The type of dermal filler product we instruct on are the less viscoelastic HA fillers available, consideration of the HA percentage concentration is also important to determine which filler would be more appropriate. The techniques vary based upon preference such as hypodermic injection or blunt tip cannula injection which are taught at our advanced training seminars. Hypodermic injections inherently have a greater risk but blunt tip cannula injections for the application of dermal fillers requires additional training and practice since both injections are supraperiosteal in an area that is highly vascularized. My suggestion would be to attend advanced training on dermal fillers such as our Advanced Botox & Dermal Filler Program II where we will go over in detail standard of care, protocols, and patient selection to ensure that if you perform these procedures they are done in a safe and effective manner.

@@Empiremedicaltraining great reply