I have been doing quite a bit of reading on this and there seems to be differing opinions. Looking at my pictures, what do you think would be the best, long-lasting approach? These are genetic, as I have had them my whole life, but now as I am about to turn 37 they are looking much worse. The skin directly in the hollow is now starting to look all wrinkly and crepey. When I look in the mirror it is all I see and the concealer just isn't doing it anymore (not like it ever did).
What Would Be the Best Approach to Fix my Tear Troughs? (photo)
Doctor Answers (9)
Fixing tear thoughs hollows
I usually use a combination approach, using Restylane ( a hyaluronic acid filler) via a blunt tipped cannula to fill in the depressions and correct the lack of volume in this area. If there is a bluish discolation prior to treatment, I tint the Restylane with a tiny amount of Radiesse ( a filler that is milky white in color) and this approach typically softens the bluish discoloration present in this area. To address the crepiness of the skin and brownish discoloration, I use laser resurfacing, which significantly improves this concern, and finally, a good vitamin K based under-eye cream completes the treatment protocol.
Fix tear troughs permanently with silicone
I've studied all the pictures you submitted. Injecting micro droplets of liquid silicone can erase the tear trough depression. The added bulk may minimize some of the fine wrinkling noticeable on smiling as well.
Minimally invasive methods to correct the under eye hollows
As a first line option I always encourage patients to try hyaluronic acid fillers such as Restylane to the tear troughs. This can be performed in the office with only two or three injection sites. In fact, I have started to use blunt tip cannulas to avoid bruising in this area. This technique has truly revolutionized my practice as my patients are able to return to work the same day looking rejuvenated without the traditioanlly bruising associated with surgery or fat injections. Typically the results can last a year or greater.
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There are surgical and non surgical procedures to improve tear troughs. These include surgical procedures including eyelid surgery, fat grafting as well as non surgical procedures. During your consultation and examination with your doctor the options most appropriate for you can be discussed.
Filler for tear trough
A good solution for you would be to fill the tear trough with filler product like restylane. That might be a good start for you based solely on your photos.
Restylane is a great first line option
As mentioned previously, hyaluronic acid fillers are a great option to start. It is less expensive than fat grafting [though over the long haul may rack up the vials and cost], and is less risky since it can always be reverse if you don't like the result. The trick is to layer the product deep, on top of bone, to avoid the bluish discoloration of skin since with superficial placement of product.
The crepiness of skin when you smile, will probably not be improved with the Restylane injection however. The quality of skin will be improved with a skin peel, or laser resurfacing.
In fat grafting, proper technique is paramount, since the results will last quite a long time. Thus, a double edged sword.
Treatment for Teartroughs
I agree with Dr Delia's recommendations. You may also seek a Facial Plastic Surgeon, or Occulopastic surgeon in your area. The other advantage of HA's is that they can be dissolved should you get a less than expected result. Also, the filler will not improve on the blue hue under the eyes (dark circles).
Tear Trough Treatment
Use of HA fillers such as Restylane works very nicely for treatment of tear troughs. The filler may last 6 months or more and if done carefully works well in this location. There are surgical options utilizing fat grafts from fatty deposits around the eye. These techniques may be longer lasting but may lead to some problems with the thiner skin in this area if not done carefully. Consult a board-certified plastic surgeon in your area for further evaluation and treatment.