Combination Approach to Tear Trough Deformities and Under Eye Appearance Using Microfocused Ultrasound With Visualization and Hyaluronic Acid Filler

Filler for tear trough deformities and improved under eye appearance has become a well-accepted procedure to treat fine lines, wrinkles, shadowing, darkness, and hollowness. Microfocused ultrasound with visualization–induced skin tightening can be a powerful modality to treat periocular laxity on its own. There is also considerable rationale for combining these 2 modalities for synergistic rejuvenation of the entire periocular area. This case series recruited participants with mild-to-moderate skin laxity in the periocular area and tear trough deformities. Participants received microfocused ultrasound with visualization therapy followed 3 months later by injection with Cohesive Polydensified Matrix hyaluronic acid gel. Photographs were taken at baseline, 3 months after microfocused ultrasound with visualization therapy, and 1 month after Cohesive Polydensified Matrix hyaluronic acid injection for rating by physicians and participants using the Global Aesthetic Improvement Scale. All participants also completed a satisfaction questionnaire. This pilot study enrolled 10 participants ranging in age from 35 to 55 years. After microfocused ultrasound with visualization alone, physicians rated 4 participants “much improved,” 5 “improved,” and 1 with “no change.” After participants had received both treatment modalities, physicians rated 9 participants as “very much improved” and 1 as “much improved.” Participant satisfaction was high with microfocused ultrasound with visualization alone and even higher with the combined treatment approach with all 10 participants reporting their periocular appearance “very much improved” at the end of the study. No treatment complications were observed. In conclusion, microfocused ultrasound with visualization in combination with Cohesive Polydensified Matrix hyaluronic acid gel was effective at improving appearance of the eye area in participants with periocular skin laxity and tear trough deformities.