The Tick technique: A method to simplify and quantify treatment of the tear trough region.

BACKGROUND: The hollowing of the infraorbital area (tear trough) is anatomically complex, and complications are frequent with its treatment. A simplified, quantifiable, and reproducible technique should encourage more novice injectors to confidently address this region. AIMS: The aim of this study was to evaluate the efficacy of a simplified method of treating the tear trough by using BD insulin syringes with fixed 6 mm 31G needles. PATIENTS/METHOD: A total of 150 sequential patients were divided into Hirman's three grades of tear trough deformity and were injected with up to three small boluses of hyaluronic acid at three defined anatomical regions. The amount injected varied with the grade of volume loss but all injections were deep on periosteum and under the orbicularis oculi muscle. Patients photographs before and after were reviewed to assess the outcome. RESULTS: All patients at all time points (immediate, 1 week, 1, 3, 6, and 12 months) were improved by patient and physician assessment. Approximately 90% at all time points rated their results as "very" or "exceptionally" improved. Adverse events were short term and included swelling, redness, pain, and bruising. No adverse events seen after the 1-week visit. No Tyndall effect was noted throughout the study and no filler required removal. CONCLUSION: This interventional-observational study illustrates the value of a simplified and quantifiable injection technique with predictable and satisfactory outcome and a low complication rate. We propose a possible way forward for aspiring aesthetic physicians to treat tear trough with confidence to minimize complications and maximize the outcome.

Bullous pilomatricoma: a stage in transition to secondary anetoderma?

Pilomatricoma is an uncommon hamartomatous tumor of the hair matrix. Bullous and anetodermic changes over pilomatricoma are rare. We report an 18-year-old male with an asymptomatic nodule with overlying cystic changes on the left arm of 6-month duration with clinical and histological features of both bullous and anetodermic modifications. We also reviewed the associated literature to conclude that there is sufficient overlap in these two entities. Both variants show a bullous or pseudobullous appearance clinically and loss of elastin, sparse collagen bundles separated by intense edema, and dilated lymphatics/blood vessels in the dermis overlying the tumor mass histologically. We therefore propose that bullous, pseudoampullary, anetodermic, and lymphangiectatic forms should be considered as synonymous or transitional to the ultimate scar-like anetodermic appearance.