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hi everyone dan julian here nurse practitioner for dan aesthetics medical this is our clinic located in the heart of ottawa today we are talking about the tear troughs the easiest place on the face to inject poorly that is lets get into it i know its a bad joke all right so before we begin lets just cover a little bit of anatomy giving us a better understanding of what causes these tear trough deformities and what we need to avoid so heres sarah say hey sarah and basically we have an obiculous retaining ligament and a zygomaticus ligament also known as the jugul groove and sometimes these ligaments tether down harder on certain individuals really emphasizing their tear troughs also what can happen is you get a fat pad herniation right here there are fat pads there and we also have a septa wall that holds that fat back but if the wall weakens then that fat pad herniates through causing this fat pad herniation further accentuating the tear troughs theres actually a tear trough grad