Mastering Tear Trough Filler: The Three-Point Tangent Technique for Optimal Results
Achieving flawless results with tear trough fillers is a delicate art. The challenge lies in addressing the intricate contour of the tear trough while minimizing complications. In a study by Wilde et al. (2023), the three-point tangent technique is introduced as an innovative method that promises to refine your approach to tear trough rejuvenation. This research provides a detailed examination of the technique, including how to perform it, its potential benefits, and why it might just become your go-to method for tear trough fillers. (Wilde et al., 2023).
Understanding Tear Trough Deformity Anatomy
Before diving into the three-point tangent technique, it’s crucial to understand the anatomy of the tear trough area. The tear trough deformity is characterized by a deep, shadowed groove running from the lower eyelid to the upper cheek. This area is particularly challenging due to its complex anatomy, which includes:
Orbital Rim: The bony structure surrounding the eye socket.
Orbital Fat Pads: The fat pads located beneath the eye, which can herniate and contribute to the appearance of hollows or bulges.
Nasojugal Groove: The groove that runs from the inner corner of the eye to the mid-cheek.
Skin Quality: Thin, delicate skin that can show irregularities more prominently.
The tear trough deformity can be caused by aging, genetic factors, or loss of volume. When treating this area, understanding these anatomical features helps in achieving a natural and aesthetically pleasing result.
What is the Three-Point Tangent Technique?
The three-point tangent technique is an advanced method designed for administering tear trough fillers. It involves strategically placing filler along three linear tangents customized to each patient’s unique anatomy. This approach uses a blunt cannula, which helps minimize tissue trauma and enhance the overall safety and efficacy of the procedure.
Why “Three-Point Tangent”?
Customized Tangents: The three tangents are drawn to fit the patient’s specific tear trough contours.
Blunt Cannula Usage: The blunt cannula helps minimize tissue trauma and vascular complications compared to traditional needle injections.
Controlled Filler Placement: Aims for even distribution, reducing common complications like lumpiness and irregular contours.
How to Master the Three-Point Tangent Technique
Ready to try this technique? Here’s a step-by-step guide to help you get started:
1. Pre-Treatment Preparation
Begin with a thorough assessment of the patient’s tear trough. Consider the depth of the trough, any existing orbital fat prolapse, and skin quality.
Marking: Mark three key tangents on the tear trough area:
First Tangent: Starts inferior to the medial canthus and extends inferolaterally to a point aligned with the medial limbus.
Second Tangent: Runs horizontally from the medial limbus to the lateral aspect of the trough.
Third Tangent: Extends superolaterally from the lateral limbus to about 2 cm lateral to the lateral canthus.
2. The Injection Process
Anesthesia: Apply a topical anesthetic to ensure patient comfort during the procedure.
Cannula Insertion: Use a 25 gauge needle to create an entry point at each marked location. Insert a 25 gauge, 40-mm blunt cannula through the puncture.
Filler Delivery: Inject the filler along each tangent. Move the cannula in a retrograde fashion, withdrawing it slowly while depositing the filler. This method ensures even distribution.
First Tangent: Target the inferolateral area.
Second Tangent: Address the horizontal component.
Third Tangent: Focus on the superolateral section.
Post-Injection Massage: Gently massage the treated area to smooth and mold the filler, ensuring it settles in the right places.
3. Post-Treatment Advice
Advise patients to avoid makeup for 24 hours and encourage them to resume normal activities the next day. Gentle massage may be recommended to aid in filler distribution and reduce initial swelling.
Why the Three-Point Tangent Technique Stands Out
1. Enhanced Precision and Customization
Unlike traditional methods that may use multiple unstructured injections, the three-point tangent technique employs specific tangents for precise placement, reducing uneven results. The technique’s structured approach allows for highly accurate filler placement tailored to individual anatomy. With 1452 applications and 583 patients in a recent study, this method has demonstrated effectiveness in achieving natural, harmonious results. The precision in filling helps address the unique contours of each patient’s tear trough, leading to more consistent outcomes.
2. Reduced Risk of Complications
Using a blunt cannula, this technique minimizes tissue trauma, thereby reducing the risk of bruising, edema, and other complications. In a study covering the largest series to date, the three-point tangent technique showed a significantly lower complication rate compared to traditional methods:
82% of patients reported no complications.
10% experienced edema, with 50% resolving spontaneously within 4 weeks.
4.6% experienced contour irregularities, lower than the 8% reported in other studies.
Bruising was noted in just 4.3% of cases, significantly lower than the 19% reported elsewhere.
3. Superior Filler Distribution:
The controlled, retrograde linear threading approach ensures that filler is evenly distributed along the tangents. This reduces the risk of lumps and contour irregularities, leading to smoother and more aesthetically pleasing results. A study found that increasing the volume of filler injected was significantly associated with complications like edema (P < 0.00001) and contour irregularities (P = 0.012). By limiting filler volume to a mean of 0.34 mL per orbit for the first treatment, the technique minimizes these risks.
4. Lower Complication Rates
Research indicates that this technique significantly lowers the rates of common complications such as edema and contour irregularities. With fewer complications, patient satisfaction and outcomes are markedly improved. Notably:
0.17% of patients experienced retrobulbar hemorrhage, which was managed promptly with no lasting visual compromise.
Filler was dissolved in just 1.9% of cases, a lower rate compared to 5.15% reported in other studies.
Conclusion
The three-point tangent technique is more than just a new method—it’s a game-changer in the world of tear trough rejuvenation. By focusing on precise, controlled filler placement and minimizing complication rates, this method provides a significant advantage over traditional techniques. For practitioners aiming to achieve exceptional results and enhance patient satisfaction, incorporating this technique could be a game-changer.
With its proven track record and lower complication rates, the three-point tangent technique is worth considering for your next tear trough treatment. Dive in, experiment, and see how this innovative approach can transform your practice!
Reference:
Wilde CL, Gupta A, Lee S, Ezra DG. Tear Trough Filler Using the Three-point Tangent Technique: Lessons from 1452 Tear Trough Applications. Plast Reconstr Surg Glob Open. 2023 Jun 9;11(6):e5060. doi: 10.1097/GOX.0000000000005060. PMID: 37305194; PMCID: PMC10256367.
Wong CH, Hsieh MKH, Mendelson B. The tear trough ligament: anatomical basis for the tear trough deformity. Plast Reconstr Surg. 2012 Jun;129(6):1392-1402. doi: 10.1097/PRS.0b013e31824ecd77. PMID: 22634656.
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