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.

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39 Doctor Answers | Asked by david_k in UK

Doctor Answers (39)
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Tear trough correction

Restylane or Juviderm, being soft and clear, is an excellent way to treat the tear trough alone. If there is also bulging fat, a transconjunctival blepharoplasty with fat repositioning will be more appropriate. You surgeon can tell you what you need.

For Best Results - Enhance Facial Volume

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 cheeks, especially the upper cheeks. This can often lead to a deep valley, right underneath the lower eyelid, causing the lower eyelid to look like it is bulging out. Previously, almost all... more

Many options

Our preferred option for your situation might be to do a transconjunctival blepahroplasty with fat repositioning and slight fat reduction, followed by fillers (usually Restylane or Prevelle). Pure fat transposition procedures can be prone to relapse of lower eyelid fat bulges as the attached fat contracts with healing, visibility of the transposed fat, or lumpiness in this very thin skinned area. Extensive deep use of fillers are also possible around the eyes and may be the least... more

Transconjunctival arcus release is best option for tear troughs

I have been doing the transconjunctival arcus marginalis release and fat grafting and repositioning for the past 6 years, and transcoinjunctival blepharoplasty with fat removal for 14 years and have never had a problem or injury of the tear duct--it just is not a problem. I also recommend against tear tear trough implants. They can extrude, and placement through transconjunctival incision is difficult. They also can be visible because the skin is thin. Whole autologous fat grafts or fat... more

Tear Troughs

I prefer the transcutaneous approach to release the arcus marginalis and reposition the available fat. Juvederm is an option. The downside is that it is temporary. Also, the periorbital region is the least forgiving place to inject fillers. The skin in this region is thin and will potentially demonstrate any irregularities in the filler. When performed well, a lower blepharoplasty is a much longer lasting resolution.

Tear trough abnormality can be fixed by injection or lower eyelid surgery.

A "tear trough" abnormality is a small indention in the bone of the nose near the lower lid. The depression can cast a shadow that often is unwanted. Dermal fillers can be used periodically to fill the depression. During lower eyelid surgery, fat that might otherwise be removed can be transferred to the depression to fix the problem permanently.

Approach for tear troughs

The approach to the tear troughs is a complex question and is dictated by the patients individual anatomy and characteristics. Common techniques that are approached by themself or in conjunction include: Correction with filler (fat, HA) (See below weblink for just filler) Reposition of fat Removal of fat lower eyelid All of the above are extremely technique sensitive and both the choice and application of the technique are surgeon dependent....

You need more volume for tear troughs

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 placed on the orbital rim, and all the way up to the medial canthus (inner corner) if the injections are placed in the correct plane. Restylane injections may do wonders for your... more

Tear Trough Hollow

Hi David, I would fill your hollow conservatively with Restylane initially, have you return to the clinic in about 10-14 days for a possible touch up. The entire lower and lateral periorbital area needs to be in balance, usually there may be some feathering injections around the main defect to blend the entire area. Restylane lasts surprisingly long in this area as there is little movement. Patients vary, but one year to eighteen months is common. There is some new collagen laid down... more

Michael A. Persky, MD

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Los Angeles Facial Plastic Surgeon

drpersky.com

No right answer

The best thing to do is discuss this with some one that has had experience with all of the techniques. Here is an analogy. If you consult with a person and the only tool they have is a hammer, they will treat everything like a nail. If you discuss your options with a plastic surgeon that does injections as well as blepharoplasty procedures you can make an informed decision and not have to hear a sales pitch for their technique. Filler injections are a great option and they can be done at... more