How can I get rid of hereditary undereye hollows/tear troughs? What's my best option, Restylane, Fat grafts or surgery? (Photo)

I believe the best correction for you would be fat injection. It is more permanent. Fillers may leave you with a gray cast in the area of filling. Fillers can last 2-3 years, but the gray color may not be ideal. Fat injection with either platelet rich plasma or stromal vascular fraction is highly reliable in the face, and it is more permanent and will have a more normal color.

You may want to talk to a doctor to see if fillers may work for you. Maybe talk to them about Belotero, or what other fillers they recommend. this is something that you do not need surgery for unless it is necessary

Your comment "I want to fix my eyes but am afraid I'll choose poorly and end up with a botched face" is an important one to take into account: do not undergo surgery as a first approach. If you get a sub-optimal result, you will forever be bothered by your eyelids and the result. Even in the best of hands, results may not meet the requirements of the patient.In your case, a conservative approach is judiciously-placed restylane and the use of topical cosmeceuticals (Vitamin C and A serums, niacin, etc). This will give you a result which is not permanent but can last a year or more, in many instances. Furthermore, you will not have to be anxious about an irreversible change. You can always explore surgery later or, when the changes are more dramatic.Remember: an improvement is to be enjoyed. A complete "cure" may be a recipe for potential disappointment. If you have Pakistani genes, be very careful about any suggestion of ablative lasers like the CO2 laser: not appropriate for you.Best of luck.Prof. BCK Patel MD, FRCS

Thank you for the question and sharing your photo and concerns.  Under eye bags and hollowing can occur in younger people who inherit that anatomy.  Eyelid surgery reduces the volume of fat to smooth the appearance of the lower eyelid and can be an effective long term solution.  Lack of cheek support can also contribute to the hollow appearance of the undereye area and improved with fillers or fat injections.   I would consider evaluation by a facial plastic surgeon or other cosmetic surgery specialist to discuss your options."This answer has been solicited without seeing this patient and cannot be held as true medical advice, but only opinion. Seek in-person treatment with a trained medical professional for appropriate care."

There are many ways to treat dark circles, as well as under eye wrinkles and bags. It is important to note however, that the majority of times the cause for discoloration is genetic and due to the viability of the blood vessels below the skin. A combination approach is always needed to get the best results in this area and this includes: topical skin care, laser and/or radiofrequency treatments, and fillers if placed appropriately. All my patients are on topical lightening agents, typically a vitamin C serum product in the AM and a brightening agent and/or a vitamin A based product in the PM. Sun protection is essential.Resurfacing and tightening are essential. My patients get offered a menu of options, for which a combination gives the best results. Light salicylic acid peels help give textural and pigment improvement; nonablative lasers (Fraxel or Clear + Brilliant) can be used to tighten and improve fine lines/wrinkles and crepe skin; fractional radiofrequency devices (Sublative, Viva) are cutting edge and improve texture, tone, and wrinkles with very little downtime; radiofrequency with pulsed electromagnetic fields (Venus) are amazing for puffiness and bags, in patients who do not want eyelid surgery; appropriately placed fillers can replace lost volume, cover up the vessels and fat pads below improving the appearance -- patients should pick a well experienced practitioner to prevent complications such as Tyndall (blue discoloration) and irregularities, one that uses a cannula for injection will help give results with little bruising or swelling; microsecond Nd:YAG laser treatments (Laser genesis) has produced dramatic improvement in discoloration in some of my patients and is safe in dark skin types, similar to the radiofrequency devices. For lifting, ablative laser resurfacing such as co2 laser combined with monopoloar radiofrequency deep heating (thermage) give amazing results. The key is for a patient to see a cosmetic dermatologist with experience in all the latest devices and techniques so the persons goals can be met by a combination approach of individualized treatments and skin care. In some cases, those who smile and have crepe skin or under eye wrinkles, a small amount of neurotoxin (botox, dysport, xeomin) strategically placed in the lower eyelid skin can improve wrinkles dramatically and give the eye a more "open" appearance.