Nasolacrimal furrow correction

The nasolacrimal sulcus is present in almost every person. It is a fold about 15 mm long, running from the inner corner of the eye downward to the cheek and cheek-maxillary area. The fold becomes especially noticeable and deeper with the onset of age-related changes in the body. Aggravate the process of various stresses, lack of sleep. A separate role is played and heredity. It is in such cases, in order to return the face more youthful and healthy look, correction of the nasolacrimal furrow is carried out.

Indications for the procedure

The anatomical concept of the nasolacrimal sulcus defines an intermediate zone between two fat layers: the medial cheek and the infraorbital. This zone has a muscular connection to the bony structure of the suborbital area, which is called the septa. If these muscle fibers weaken - for example, due to sleep deprivation, stress, poor diet, bad habits - the nasolacrimal sulcus becomes more prominent, so the question of its correction is often raised.

The septa changes with age, and nearby fibers and tissues are also transformed. An arc-shaped fold under the lower eyelid appears, the skin near the corners of the eyes darkens, which is associated with the deterioration of local metabolic processes. As a result of these changes, the face acquires a tired, haggard look, which does not add to a person's attractiveness.

The age at which the correction of the nasolacrimal sulcus may be required may be different, which depends on individual characteristics, heredity, etc. Accelerate the process of defect formation by such factors as:

• smoking, drinking alcohol;
• high amount of carbohydrates in the diet, improper and incomplete nutrition, severely restricted diet, drastic weight fluctuations;
• endocrine diseases (thyroid disease, diabetes mellitus, etc.);
• prolonged stay in cold conditions, lack of sleep, heavy physical exertion;
• stresses.

In the early stages of the development of the problem can help cosmetologist, masseur. In more complex cases, instrumental correction of the nasolacrimal sulcus will be required.

Preparation

During the preliminary preparatory examination before the correction of the nasolacrimal sulcus, the patient should tell the doctor about his lifestyle, past and existing diseases, current state of health, medications taken. Next, appropriate diagnostic measures should be carried out, which may include:

• general blood test, biochemical blood test examining levels of total protein and bilirubin, AST and ALT, creatinine and urea, glucose and electrolytes;
• urinalysis;
• determination of blood type and Rh factor;
• Wasserman reaction, blood tests for human immunodeficiency virus, hepatitis B and C (HBsAg, HCV);
• coagulogram (assessment of the quality of blood clotting);
• electrocardiography;
• fluoroscopy or chest x-ray.

In addition to standard investigations, the patient may be advised to:

• to check the quality of visual function;
• assess eyelid tone, functional abilities of the oculomotor muscles and optic nerve.

If there are indications, the patient is additionally referred for consultation to an ophthalmologist, neurologist.

It's important to know:

• Laser vision correction can be performed no later than six months before blepharoplasty, or no earlier than six months after the procedure.
• Introduction of botulinum toxin in the periorbital area is possible four months before plastic correction, or not earlier than four months after it.

If the correction of the nasolacrimal sulcus with local anesthesia is supposed to be performed, it is necessary to pay attention to the following points:

• Two or three weeks before the procedure, you should stop taking medications that affect blood clotting (antiaggregants, antithrombotic agents), hormonal drugs (including birth control pills).
• Beforehand, it is necessary to balance the diet, give up alcohol and smoking.
• If indicated, additional vitamin supplementation may be prescribed.
• An anesthesiologist should be consulted a few days before surgical correction of the nasolacrimal sulcus.
• A few hours before the procedure it is recommended to stop eating and drinking (optimally - 5-6 hours).
• On the eve of correction you should not use cosmetics (including creams, tonics). It is necessary to wash your face thoroughly, brush your teeth. Use scrubs and other aggressive effects on the skin before correction is categorically not allowed. If there are false eyelashes, they must be removed.
• You should bring the things recommended by your doctor to the clinic. In most cases it is a matter of pre-arranged personal and medical documentation, sunglasses.

Nasolacrimal furrow correction is a non-urgent treatment, so women should plan it during the absence of menstrual bleeding. This is due to the fact that during menstruation, the properties of blood change, differently acting drugs for anesthesia, possible general ill health of the patient. To avoid trouble and complications, correction of the nasolacrimal furrow is advised to do a week before the period or a week after their completion.

Technique of the nasolacrimal sulcus correction

Correction of the nasolacrimal sulcus can be performed conservatively or surgically. Surgery is prescribed only in particularly neglected situations, when non-surgical methods will not be able to achieve the desired result.

The leading non-surgical methods include:

• Mesotherapy - involves microinjection of preparations, the composition of which is represented by amino acids, vitamins and minerals, lipolytics, protein groups, hyaluronic acid. Mesotherapy is recommended to prevent the appearance of nasolacrimal fold, or to eliminate the problem at an early stage of development.
• Contour plastic surgery is performed with the help of hyaluronic acid fillers. Fillers are relatively dense, they are injected using a special elastic hollow tube - cannula. With its help it is possible to transport fillers to the periorbital area, located between the nasolacrimal zone and the lower eyelid. After the procedure, the nasolacrimal fold is practically smoothed, the skin under the eyes is lightened. The effect is retained for about 12 months, after which the correction should be repeated.
• Injectable lipofilling - is a kind of analog of surgical lipolifting, but this procedure involves the introduction of fat tissue not through an incision, but through punctures through a special cannula. Injectable lipofilling is much less traumatic, the effect is retained for 1-1.5 years, after which it is recommended to repeat the correction.
• Radio wave lifting works by using high-frequency electromagnetic vibrations to stimulate an increase in the number of fibroblasts and the synthesis of elastin and collagen fibers. Radio wave frequencies, which function in the range of 300 mHz - 4 kHz, can heat up the tissues until the regeneration process is triggered in them. It is noteworthy that this process continues on its own for several months after the procedure is completed, and the effect lasts for 3-5 years.
• Thermage is a correction that resembles the above-described procedure of radio wave lifting, but it involves a more intense heating of tissues with electromagnetic oscillations - up to 60°C. The effectiveness of the procedure is particularly noticeable, but there are risks of scarring. The effectiveness of the procedure is particularly noticeable, but there are risks of scarring.
• Ultrasonic lifting is accompanied by the penetration of ultrasound waves into the tissue at 5 mm, which leads to a point thermal contraction of fibers. As a result, an isolated microscopic burn occurs inside the tissue, externally tightening the skin and subcutaneous fat layer, mimic muscles, fascia, stimulating the formation of elastin and collagen fibers. The effect is fixed for 8 weeks and lasts for several years.

Surgical methods of nasolacrimal sulcus correction:

• Surgical lipolifting is performed if the cause of defect formation is a decrease in skin tone and so-called "failures" of fatty tissue. In most cases, this procedure is prescribed for young people who do not suffer from other cosmetic problems - in particular, ptosis. During the lipolifting operation, fat tissue is transferred from the thigh or abdominal region to the nasolacrimal sulcus area, for example. The intervention is performed using local anesthesia and lasts no longer than 60 minutes. A conjunctival or skin incision is used to transfer the tissue.
• Blepharoplasty is recommended for patients in whom the nasolacrimal sulcus is not the only problem, but is accompanied by other disorders: ptosis, eyelid hernia, a large number of wrinkles. The operation consists of separating the fat layer of the lower eyelids and lowering it into the subcutaneous space in the area of the nasolacrimal sulcus. Simultaneously carry out other manipulations in the framework of classical blepharoplasty. [1]

Preparations for correction of the nasolacrimal sulcus

1. Hyaluronic acid preparations (hyaluronic acid fillers) are organic products that demonstrate effectiveness in wrinkle correction, skin rejuvenation. After injection, the molecules of the active component are gradually released, attract moisture, activate the synthesis of collagen and its own hyaluronic acid in the tissues, stimulate local immunity, prevent the processes of photoaging of the skin. Even a year after the correction of hyaluronic acid nasolacrimal fold has a smoother appearance than before treatment, despite the biological degradation of the material. In addition to correcting wrinkles and folds, injections help to reduce pigmentation and lighten dark circles under the eyes. In most cases, hyaluronic gels with soft to medium molecular bonding and medium density are used. The gel concentration ranges from 18 to 24 mg/mL. Such correction does not require a large number of injections - almost always one session is enough, except for neglected cases with a strongly pronounced nasolacrimal fold. The duration of the effect after correction is individual and depends on the selected preparation of hyaluronic acid, the quality of subsequent care, age. Most often the result is retained for 1-2 years.
2. Hyaluronic boosters are a combination of hyaluronic acid fillers and biorevitalizants. Such mixtures act faster and more effectively, provide soft filling, especially recommended for owners of thin sensitive skin near the eyes. The only disadvantage of such preparations is the relatively rapid leveling of the effect, compared to fillers - the result is retained for six months to a year.
3. Combinations of other fillers with biorevitalizants are used within the framework of biorevolution. Correction is carried out in 1-2 sessions with the use of local anesthesia. Retention of the result is possible for 8 months to a year and a half, which depends on the selected preparation, quality of post-procedure care and individual characteristics.
4. Biorevitalizants containing unbound hyaluronic acid are used for prevention and at the stage of early nasolacrimal furrow formation. One to four correction sessions may be required for an adequate effect. The duration of the effect is usually from six months to three years, depending on the selected means and individual characteristics. Such preparations include the neocollagenesis agent Ellanse, Redies and their combinations.
5. Plasmogel is used for the procedure of plasmolifting - filling the nasolacrimal sulcus with the preparation of own plasma. Such an effect activates the formation of endogenous collagen fibers and its own hyaluronic acid. Correction can include from three to six sessions, the duration of retention of the result - up to three years. Plasmolifting is successfully combined with hyaluronic acid preparations.
6. Preparations of polylactic acid improve the density and elasticity of the skin, remove the nasolacrimal furrow, strengthen tissues without causing swelling.
7. Biopolymeric agents with bionegradable synthetic filler.

If the problem in the form of nasolacrimal furrow is at an early stage of development (that is, it appeared recently), it can be eliminated with the help of hardware cosmetology - in particular, sessions of ultrasound lifting, electromagnetic influence. Such correction is able to slow down the aging of tissues, visibly improve appearance. These techniques are more suitable for young people with a slightly pronounced nasolacrimal furrow.

The most common technique that successfully eliminates the nasolacrimal furrow is correction with fillers. This is a minimally invasive injection of certain drugs that "fill" the furrow from the inside. During the intervention, the specialist with the help of injections fills the deficit of tissue volume, which allows you to eliminate the problem and at the same time smooth out nearby fine lines. Often use fillers containing hyaluronic acid. This component optimizes the appearance of the skin near the eyes, perfectly moisturizes tissues, activates natural rejuvenating processes, being a natural substance for the body. In the course of the procedure quickly disappears even quite pronounced nasolacrimal furrow, correction with hyaluronic acid does not provoke a rejection reaction, and the substance itself after a certain time is removed from the tissues and the body.

Hyaluronic acid accumulates moisture around itself, stays well in the area of injection, perfectly amenable to modeling. The product is injected with a fine needle without obvious damage to the skin. The results are fast and stable.

Correction of nasolacrimal sulcus with spherogel

Spherogel is a bioregenerant substance that is not a filler or revitalizer. The drug stimulates the tissue repair reaction, activates the production of its own intracellular matrix.

Spherogel is represented by such components:

• fragmented structural proteins (glycoproteins and proteoglycans);
• sialic, glucuronic, uronic acids;
• monosaccharides;
• with heparin;
• amino acids.

Spherogel contains animal components (collagen type 4), which is obtained from chicken sclerae. The preparation fills the problematic nasolacrimal sulcus, smoothes irregularities, provides conditions for cellular regeneration.

To correct the nasolacrimal sulcus, you can use:

• Spherogel Lite (papular, linear-retrograde, linear injections) course injection in 2-6 sessions with a frequency of once every two or three weeks.
• Spherogel Medium (linear, linear-retrograde, bolus injections, cannula reinforcement) course injection in 2-4 sessions with a frequency of once every 8-12 weeks.
• Spherogel Long (linear, linear-retrograde, bolus injections, cannula reinforcement) course 1-2 sessions with a frequency of once every 3 months, six months, a year.

Correction of nasolacrimal sulcus with plasmogel

The principle of action of plasmogel is similar to the action of fillers, but this product is devoid of hyaluronic acid, which prevents the appearance of edema and some other unpleasant consequences of correction of the nasolacrimal furrow. Autologous gel is made from the patient's own blood plasma using modern technology, which has a number of advantages over other preparations:

• the procedure is completely safe;
• does not cause allergic processes and swelling;
• provides visible effect almost immediately, with its strengthening over a month;
• stimulates natural regenerative reactions in tissues;
• the result is retained for 1 year or more.

In order to obtain plasma gel, venous blood from the patient is required. It is placed in a centrifuge, plasma is separated, which is then drawn into syringes and transferred to a special device that converts liquid plasma into a gel-like state. The resulting gel is used for injection into the tissues in the area of the nasolacrimal sulcus using special cannulas.

Correction plasmogel is allowed to combine with some other methods - in particular, with the introduction of fillers or reinforcement with threads.

Correction of the nasolacrimal sulcus with polylactic acid

Polylactic acid is a synthetic absorbable agent that is successfully used for contour plasty. It is represented by a crystalline suspension of polylactic acid in isotonic sodium chloride solution. When entering the tissues, the drug activates fibroblasts and collagen, which allows you to give volume and fill the necessary areas. Approximately two weeks after the introduction of moisture from the drug is replaced by the patient's own collagen, the acid is decomposed into carbon and water, and dense collagen fibers are formed. Directly polylactic acid is retained in the area of the nasolacrimal sulcus for more than 2 years - often up to five and even seven years. Newly formed collagen is retained for one and a half to three years.

Injections of polylactic acid trigger a number of rejuvenating processes. Activated fibroblasts begin to stimulate the release of collagen, elastin, fibronectin, intercellular components. Normalizing and renewing reactions start, cellular and intercellular structure is restored.

Correction of the nasolacrimal sulcus with threads is called vector lifting, or bio reinforcement, because polylactic acid as if reinforces (strengthens with peculiar threads) all tissues in the place of injection. Along the vector lines are formed polylactic acid threads, around which collagen and elastin fibers are formed, further supporting the elasticity of the skin and preventing the formation of the nasolacrimal furrow.

The correction is considered highly effective, and the result can be compared to a surgical lift. The injected drug forms a kind of subcutaneous framework, thanks to which the tissues in the nasolacrimal sulcus area are fixed. The effectiveness of the procedure is not immediately apparent, but becomes most noticeable after a few weeks.

Nasolacrimal furrow: massage correction

Massage can be successful in correcting the nasolacrimal sulcus if the problem is at a very early stage of development. The procedure is carried out only on clean skin, so first make sure to demake the skin, for example, with cosmetic milk or micellar water. Then apply a nourishing cream for the area near the eyes, or the appropriate serum. Hands should also be clean.

Since the nasolacrimal sulcus area is quite sensitive, you should not use massage oil or ordinary face cream. It is important to apply only specially designed products for the periocular area that have ophthalmologic recommendations. It may be necessary to apply an additional cream or serum during the massage to prevent excessive stretching of the tissues.

• Use the index and middle fingers of the hands to make light circular movements from the outer corner of the eye to the temples.
• Circular movements with slight pressure are gradually directed along the lower orbit from the temporal region to the nose. Repeat several times.
• Place the pads of your fingers on the lower eyelid and press lightly on it for a few seconds. The eyes are closed.
• Use the index and middle finger to pat from the temporal area to the nose along the lower orbit.
• Rolling: place the pad of the middle finger between the outer corner of the eye and the temple so that the nail plate "looks" at the temporal side. Slightly pressing on the skin, roll the finger along the lower orbit towards the nose. Repeat at least five times.
• Perform circular movements around the eyes using index and middle fingers: along the lower orbit from the temple to the nose and along the upper orbit from the bridge of the nose above the eyebrows to the temporal area.
• The session is completed by patting with the pads of the fingers along the previously marked directions.

After the procedure, the face is washed with cool water (you can also perform contrast washing, which is even more effective). Such correction is carried out regularly, for a long time, until the permanent effect is fixed.

Correction of nasolacrimal sulcus at home

The appearance of the nasolacrimal furrow is most often hereditary or age-related. Choosing a way to correct this problem at home, you should understand that no folk remedy can not solve it completely. Nasolacrimal furrow is "laid" at a young age, especially when a person expresses his emotional state: laughs, squints, and even just blinks a billion times.

As we age, collagen and elastin synthesis decreases and the nasolacrimal sulcus appears along with other age-related wrinkles and folds.

And yet, is it possible to make the nasolacrimal furrow less noticeable at home? First of all, for this purpose it is necessary:

• give up bad habits (smoking - the enemy of beauty, as well as other such habits);
• make a habit of not squinting, using sunglasses;
• drink more clean water (dehydration of the skin should be corrected first from the inside, and only then rely on the effect of external remedies);
• Use appropriate, gentle skin care products near the eyes.

Of course, such recommendations are more preventive in nature, because it is easier to prevent the problem: it is much more difficult to get rid of the already formed nasolacrimal furrow. No cream can "in one click" smooth out a wrinkle or crease: the skin near the eyes needs special and regular care, including:

• compulsory de-makeup and washing, without obvious friction and stretching of the skin, using special products for delicate gentle cleansing;
• systematic use of moisturizers and nutrients, application of special gel or cream under the eyes.

Do not use scrubs in the area near the eyes. Mild exfoliating creams may be used.

To correct the nasolacrimal furrow, a nourishing and moisturizing cream alone will not be enough. To correct the nasolacrimal furrow, a nourishing and moisturizing cream alone will not be enough.

Cosmetic masks can be effective in many cases. They can be fabric, gel, cream, day or night masks. It is important to use them not from time to time, but regularly, at least once a week, but not every day (overloading the skin is also undesirable).

Serums are applied under the cream, on clean skin. This treatment enhances hydration and nutrition, stimulates the synthesis of collagen fibers and prevents their destruction, which makes the nasolacrimal furrow less noticeable.

It is recommended to choose products containing hyaluronic acid, vitamins, antioxidants that slow down the ageing process. At a more mature age, you should give preference to anti-aging products containing peptides, retinol, collagen.

Another effective tool for correcting the nasolacrimal furrow is patches. They can be collagen, hydrogel, fabric. Patches are applied for about half an hour and removed as they dry. It is not possible to wear such products for a long time or use them too often, because of the high risk of drying out the skin.

Prevent the appearance of the nasolacrimal sulcus, or smooth it out in the early stages of development in most cases is possible. In more complex and neglected situations, it is still recommended to visit a specialist. A qualified cosmetologist will assess the extent of the problem and offer the most appropriate injectable or hardware manipulations.

Contraindications to the procedure

The more complex is the correction of the nasolacrimal sulcus, the more contraindications will be voiced by the specialist. Thus, radiofrequency and ultrasound lifting is contraindicated if the patient has:

• tumors, both benign and malignant;
• high blood pressure or a tendency to have high blood pressure;
• pregnancy;
• dermatologic pathologies;
• any skin problems or lesions in the area where the procedure is to be performed;
• the presence of silicone implants in the area of planned exposure.

Correction with fillers (injections of hyaluronic acid) is not performed:

• during pregnancy;
• in endocrine and metabolic pathologies (diabetes mellitus);
• viral diseases, oncopathologies;
• in case of individual hypersensitivity to the substances used.

The lipolifting procedure is contraindicated:

• for clotting disorders;
• in malignant and benign neoplasms;
• with diabetes;
• during pregnancy;
• in pathologies of the heart and blood vessels, decompensated conditions.

Blepharoplasty cannot be performed:

• with high intraocular pressure, glaucoma;
• with diabetes mellitus, blood clotting disorders;
• during pregnancy.

Correction of the nasolacrimal sulcus with fillers is not performed:

• If the patient had blepharoplasty 6-12 months ago;
• if the patient's skin has an increased tendency to scar formation;
• if there is an exacerbation of chronic inflammatory processes or acute form of infectious-inflammatory diseases;
• if there are dermatologic problems, lesions in the area of the proposed procedure;
• for epilepsy, tendency to seizures;
• with blood clotting disorders, hemophilia.

Correction is carried out if the contraindications are temporary - of course, after their elimination.

Consequences after the procedure

Possible unpleasant consequences after correction of the nasolacrimal sulcus are most often due to minimal, but still tissue damage, and are detected in the early post-procedural period (from a few days to 2 weeks after manipulation). The most common phenomena are as follows:

• hematomas;
• redness of the skin;
• a little swelling;
• soreness in the area of injection.

Bruising after nasolacrimal sulcus correction is due to injected tissue damage, it goes away quite quickly, in one to two weeks.

For a few days (up to 1-2 weeks), the injected product may be palpable (often in the form of a roll), but this goes away after a while.

Swelling after correction of the nasolacrimal sulcus is particularly noticeable during the first 3 days, then its intensity decreases, although a slight swelling may persist for 3-4 weeks. Due to swelling, some asymmetry of facial features is possible, so during the first few weeks to assess the quality of the procedure is inappropriate.

Rolls after nasolacrimal sulcus correction can be palpated during the entire period of edema presence, this is considered a normal condition due to the moisturizing reaction and the presence of additional substance in the tissues. Over time, this condition stabilizes and the roller smooths out.

In isolated cases, fibrous thickenings, nodules, inflammatory processes, granulomas, abscesses, necroses may appear after correction. However, such complications are extremely rare - less than 0.01% of patients. If this happens, you should immediately visit the specialist who performed the manipulation.

Complications after the procedure

Compared to surgery and lipolifting, nasolacrimal sulcus correction is a gentle manipulation with a low risk of complications.

• We've already covered the likely small consequences:
• swelling due to trauma and tissue irritation;
• bruises, redness, roller-shaped seals (go away on their own).

In some cases, the appearance of rollers is associated with an excessive amount of injected filler. This complication is not critical, it is eliminated by additional injection of hyaluronidase.

The following complications are considered more complicated, although rare:

• ingress of infection, inflammatory reactions in the injection zone of the nasolacrimal sulcus;
• soft tissue necrosis;
• the formation of nodular elements, fibromas;
• displacement of the gel component.

These problems are usually the result of unprofessionalism of those who perform the correction of the nasolacrimal furrow, or improper skin care after manipulation.

The development of an allergic reaction in patients with individual intolerance to the composition of the injected drug is not excluded.

The most serious complications are noted in the case of unsuccessful contour plasty, violation of sanitary and hygienic rules, the use of poor-quality drugs. To avoid trouble, the correction of the nasolacrimal furrow should be addressed only to proven experienced professionals and not be tempted by cheap dubious services "at home".

Complications after surgical blepharoplasty are many times more common. It is possible to develop bleeding, infection, formation of noticeable scars, lacrimation or dry eyes. Incorrectly performed surgery can cause asymmetry of the face and eyes. [2]

Care after the procedure

Nasolacrimal sulcus correction is usually performed on an outpatient basis. After about 1.5-2 hours, the patient leaves the hospital and goes home. If at the same time with the correction was performed facelift or other similar procedures, it is possible inpatient observation for several days (often - up to three days).

The patient can return to a normal lifestyle almost immediately after leaving the hospital. However, experts advise rest and more rest for the first 24 hours, which is necessary for a smoother recovery.

Immediately after correction, there may be a nagging pain in the area of manipulation, headache. To eliminate it, it is enough to take ordinary analgesics. To prevent the appearance of swelling and hematomas, it is recommended to apply cold.

The attending physician may prescribe the use of certain eye drops, anti-edema or antibacterial ointments and creams, depending on the indications.

It is recommended to use a high pillow for sleeping.

Salt is excluded from the diet for about 2-3 days. Alcoholic beverages are excluded until the tissues are completely repaired.

For 7-10 days, you should not strain the organs of vision by watching TV, working at a computer monitor, reading and other similar activities. During the same period, contact lenses should not be worn and cosmetics should not be used. To go outdoors, you should use sunglasses. Smoking is highly undesirable.

Physiotherapy may be indicated to accelerate tissue regeneration processes. This issue should be discussed with the attending physician. The healing time is also determined by the doctor individually, depending on the extent of the intervention and the general state of health of the person. In most cases, sports training, bathing, sauna, solarium, etc. Are contraindicated during the entire rehabilitation period.

Correction of the nasolacrimal furrow is a relatively simple manipulation. But, if you ignore the recommendations for skin care after treatment, the problem can return in the near future.