San Diego Top Doc Discusses Tear Trough Deformity



Gilbert Lee, M.D., F.A.C.S., voted five consecutive years as Top Doc in Plastic Surgery by the San Diego Medical Society, discusses under-eye bags and treatments to diminish their appearance.

The eye sockets contain fat which forms a cushion for the eyeball. This peri-orbital fat is held in the eye socket by a thin orbital septum within the eyelids. As we age, the orbital septum weakens and allows the fat to bulge into the lower lids. This bulging casts a shadow below the bulge and gives us the appearance of under-eye bags. The hollow area of shadowing below the eye is the "Tear Trough".

A tear trough deformity is a deep indentation between the eye and the nose. Technically known as the nasojugal fold, this natural indentation becomes very noticeable if it gets too deep. Some people have tear troughs naturally (see negative vector orbit), while others develop them with aging. Either way, it creates a dark shadow which is cosmetically distracting. The best treatment is to build up this area of hollowing and bring this skin into the light and stop the shadow formation. This filling can be accomplished with injectable fillers such as Restylane or Juvederm, fat injections or by placement of a Flowers Tear Trough Implant.

A Flowers Tear Trough Implant inserted under the eyes will augment the cheek bone (infraorbital rim) and eliminate the shadowing. Tear trough implants are made of silicone – a soft rubber-like material that is inserted through a small incision and placed over the bone mass under the eyelid to augment its shape and create a more youthful appearance. Dr. Lee performs tear trough implant surgery with a transconjunctival method of putting implants in place by way of a small laser incision on the inside of the eyelid. By using this advanced surgical technique, there are no visible signs of scarring since there is no incision made on the outside of the eyelid. Transconjunctival tear trough implant surgery has a quicker healing time post-surgery than less effective surgical techniques and leaves no change to the shape of the eyelid. This is the most lasting and predictable treatment for tear trough deformity.

When young patients seek Dr. Lee’s advice regarding lower eyelid bags, it rarely is due to "bags", but is usually due to an anatomic imbalance called a "Negative Vector Orbit." Patients with this condition describe themselves as having "bags" since they were very young, and that the bags are worsening with time. The anatomic finding is usually an underformed (hypoplastic) cheek bone under the eye giving you a "prominent eye" appearance (the opposite of a deep set eye). When the eyeball and the normal fat of the lower lid (periorbital fat) protrude farther than the cheek bone, they cast a shadow, giving the appearance of dark circles under the eyelids. An example of negative vector orbits can be seen in actors Susan Sarandon and Marty Feldman. Most facial models have positive vector orbits. Catherine Zeta Jones is a nice example.

Improving the eye area is key in improving overall facial appearance. Correcting a tear trough deformity restores balance and rejuvenates the entire face.  If you are interested in discussing your desired area of improvement with Dr. Lee, please call Changes Plastic Surgery & Spa at 858-720-1440. 


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San Diego Plastic Surgeon