Classification of the tear trough groove on a five-point scale
Classification using a scale is a useful tool for both understanding and teaching. A classical scale can be based on the severity of the groove: no groove, mild, moderate, marked, very marked. For example a three‑point scale is proposed as follows:
- Scale 1: no groove
- Scale 2: moderate groove
- Scale 3: marked.
Physicians should understand the changes that occur with ageing: the muscle extends downward, following the sagging of the superficial malar fat and the skin. It becomes less compact, less homogenous, and with gaps between the dissociated fibres.
An original and more scientific classification is therefore proposed, incorporating these anatomical
and dynamic points (i.e. the tonicity of the orbicularis muscle and whether the muscle is compact and dissociated).
Scales 2 and 3 can be divided into two sub-points, which take into consideration the loss of tonicity with ageing:
- Young patients with compact and homogenous muscle without gaps
- Older patients with a loss of tonicity of the orbicularis oculi muscle, with less compact, less homogenous, dissociated fibres possibly producing gaps between them.
Therefore, the classic three-point scale becomes an original five-point scale, which takes into consideration the tonicity and homogeneity of the orbicularis muscle with ageing:
- Scale 1: no groove
- Scale 2A: moderate tear trough in young people
- Scale 2B: moderate tear trough in older people
- Scale 3A: marked tear trough in young people
- Scale 3B: marked tear trough in older people.
This classification will help the physician to precisely decide on treatment protocols and precautions to be taken.
In scales 2A and 3A, an injection performed with expertise — adequate amount of product deeply and gently placed under the muscle, with a gentle pressure on the plunger of the syringe — presents a minimal risk of the Tyndall effect as the orbicularis oculi is tonic and homogenous, acting as a compact barrier.
In scales 2B and 3B, a less compact orbicularis oculi muscle with dissociation of its fibres can have gaps, allowing superficial migration of the product — even with a perfectly performed injection. In these cases, under‑treating is preferable to avoid the risk of the Tyndall effect.
Conclusions
A beautiful glance lights up the face. Enhancement and filling of the tear trough will embellish the luminosity of the glance and overall appearance. The use of hyaluronic acid products, the quality of which is constantly evolving, achieves this result. Certainly, the future of aesthetic medicine will be shaped by further research — the development of less hydrophilic hyaluronic acids resulting in less water absorption, and the minimisation of adverse events such as the Tyndall effect.
These new products will be able to be dispersed in a thin layer in areas such as the palpebromalar groove and tear trough, resulting in a natural appearance, and will have the additional benefit of a sufficiently long duration.
