Tear trough multiple procedures to improve tired look

Mark Berkowitz, MD answers: Best approach for tear troughs?

I am 30 year-old male with tear trough at lower eyelids, like dark circles. Last year, I developed some small bags that make the dark circles worse. I have no excess skin. I visited some plastic surgeons, and I was offered Restylane injections or arcus marginalis release with fat reposition (not transconjunctival, since bulging fat is very close to tear duct and hard to deal with through that approach). Is this correct? How close to the bone and inner corner of eyelid can Restylane injections go? My grooves start from the very inner corner next to tear duct.


Mark Berkowitz, MD
7 months ago

Tear Troughs can cause us to have a very tired look. Luckily, they can be greatly improved.  Restylane works beautifully to camouflage the tear trough. It  takes approximately 30 minutes for a well trained cosmetic physician to perform this complex injection. It lasts approximately 18 months time. Some patients have mild to moderate swelling after the procedure. Other fillers like Sculptra and fat can also be used within this area.

If you are looking for a looking for a procedure that will last longer, fat repositioning can be used. I perform this transconjunctivally, so there is no skin incision, no stitches and no scalpel blade! I use the Mixto CO2 laser to sculpt the fat from the inside of the eyelid and then I reposition this fat into the tear trough. I then use this same laser over the surrounding skin to improve the contour from the eyelid margin ( lash line ) to the cheek. The procedure takes approximately 45 minutes. Look for a skilled ocular plastic surgeon to perform either of these procedures.

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