The Blending Technique: A New Approach for Tear Trough Correction.

INTRODUCTION: The tear trough is one of the areas that most reflects aging. The anatomy of the preseptal, premaxillary, prezygomatic and deep pyriform spaces are essential for successful planning of filler treatments.
MATERIAL AND TECHNIQUE: This work analyzes the anatomic relationship between the origin of the orbital septum and the tear trough/ orbicularis retaining ligaments, and between the anatomical spaces and the cheek fat compartments, to classify patients who undergo a filler treatment for tear trough deformity. Patients are classified in 'innie' or 'outie' and blending technique is described based on this classification.
RESULTS: A total of 38 patients were evaluated, comprising 21 females and 17 males, with a mean age of 53 years (range, 31-72 years). The mean follow-up period was 10.4 months (range, 5-22 months). All patients presented with an innie-type tear trough deformity. Prior to treatment, 76.3% of patients (n = 29) were classified as Hirmand Type II, and 23.7% (n = 9) as Type III. Following treatment, 84.2% (n = 32) of patients were rated as "very much improved" (GAIS score of 1), and 15.8% (n = 6) as "much improved" (GAIS score of 2). The mean volume of hyaluronic acid injected per unilateral tear trough was 0.35 cc (range of 0.2-0.5 cc), and for the unilateral midcheek was 0.65 cc (range of 0.5 to 2 cc). No complications were reported.
CONCLUSION: The blending technique is an effective technique to improve the appearance of the lid-cheek junction, correcting the TT deformity and the palpebromalar groove. Patients are classified as innies or outies based on the position of the AM on the orbital bone. Innie patients are more favorable to the injection of HA in the gap between AM and ORL (preseptal space) to correct the TT groove. Outie patients benefit from the volumization and support of the DMCFP, but not from direct injection into the TT and preseptal space.
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