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.

Best approach for tear troughs?
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24 answers to “Best approach for tear troughs?”

A: For Best Results - Enhance Facial Volume

Ilya Reyter, MD
By Ilya Reyter, MD - Beverly Hills Dermatologist

The key to understanding why a face appears "older" or tired is to look at what happens to facial volume over time.  By studying MRI images of the aging face, we have learned that fat and bone are reabsorbed by the body slowly over the years.  In time, this leads to sunken, hollow looking... more

A: Implants or fat repositioning

William Portuese, MD
By William Portuese, MD - Seattle Facial Plastic Surgeon

It is not a good idea to put Restylane around the tear troughs since there are complications associated with it, and it is only temporary. Your best options are tear trough-style cheek implants or fat repositioning through a lower eyelid blepharoplasty.

A: Tranconjunctival blepharoplasty can be an excellent approach for tear trough deformity

Scott Trimas, MD
By Scott Trimas, MD - Jacksonville Facial Plastic Surgeon

Correcting the tear trough deformity can be performed via the transconjunctival lower blepharoplasty. After conservatively removing excess fat in the central and lateral areas of the lower eyelid region, the fat stalk from the medial component can be stretched out to fill the tear trough and offers excellent... more

A: Tear troughs

Steven Wallach, MD
By Steven Wallach, MD - Manhattan Plastic Surgeon

 You actually can have both. You can have a transconjunctival fat removal or redraping, release of the arcus marginalis and if needed at a later time, some filler along the arcus to camouflage better.

A: Restylane can work for tear troughs

Philip Young, MD
By Philip Young, MD - Seattle Facial Plastic Surgeon

Both of those options can help. I think Restylane would be a better alternative to replace the volume that you have lost in the lower eyelid and cheek area. That is essentially what has happened -- a loss of volume. The only thing is that restylane will last only 6-9 months. Fat repositioning can help the... more

A: Fat Grafting for under eye hollows

Michael Law, MD
By Michael Law, MD - Raleigh-Durham Plastic Surgeon

It is very important to preserve (or restore) soft tissue volume in the lower lid. When I review with eyelid surgery patients some photographs from their twenties, in most cases we find that years ago there was no visible demarcation between lid and cheek, but instead a smooth, gently convex curve extending... more

A: Best approach for tear troughs

Harrison C. Putman III, MD
By Harrison C. Putman III, MD - Peoria Facial Plastic Surgeon

For your specific problem I would recommend transconjunctival blepharoplasty with a pedicled fat repositioning with adequate arcus marginalis release. The pedicle maintains circulation to the fat graft, which is contoured to the tear trough deformity and secured with absobable pull-through sutures, usually 3-4... more

A: Contour Lower Lid Blepharoplasty

Richard Gentile, MD
By Richard Gentile, MD - Cleveland Facial Plastic Surgeon

In selecting a technique, I have evaluated all options to determine the best approach to lower lid contour issues, and I believe we have developed the best solution (in my hands).  Because there is a bulge and a hollow in many patients like you, we reduce the bulge surgically and then fill the rims... more

A: Surgical and nonsurgical treatment choices for tear troughs

Joseph Perlman, MD
By Joseph Perlman, MD - Houston Plastic Surgeon

As you can see from the below answers, all the physicians are in agreement that the problem can be treated nonsurgically with a filler, either fat or dermal injectable, such as a hyaluronic acid or calcium filler.  Injectable fillers need to be placed deep along the bone and placed slowly and carefully... more

A: You need more volume for tear troughs

Behrooz Torkian, MD
By Behrooz Torkian, MD - Beverly Hills Facial Plastic Surgeon

David, This is a very intreresting and challenging case you have brought into this arena. I think you have many great answers here... From your pictures, it looks like you have a real lack of fat.  There is fat missing, not only in your tear troughs, but in your cheeks.  Restylane injections can be... more

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Comments

david_k
12 posts
3 Apr 2009

How much Restylane is 3 milliliters of filler on each side? Considering that a syringe costs about 600$,whats the total cost?

Alan H
1 post
17 Jul 2009

I have been fighting with my under eyes since a kid. Always dark tear troughs. Now in my late 20's, Im fed up with it and thought, plastic surgery would be the answer. I have had, jurverderm, restylin, artefill all placed in the tear trough, and my body ate the hydro acids within 2 weeks. The artefill beads brought the collagen back, but when I was ready for my next layer, the FDA distribution company dropped it. Once again, out of luck, I went to the fat transfer answer. That's hell, it's lumpy, you have black and blues for months under your eyes that are filled with fat and bloated. Then 120 days later, you have clean under eyes with lumpy bumps, and your tear trough is still dark. Everything is an experiment, and everyone has another risky answer that doesn't provide results. I think my last chance of a permanent fix would be tear trough implants. Has anyone had them? There's a place in Beverly Hills, and a non permanent chance of using calcium filler Radiesse. Anyone who cured tear trough deformity have some suggestions?

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