I need advise on my tear trough deformity; I'm here to find a physician to preform said procedure before 9/26/16? (Photos)

As you can see I have a serious tear trough deformity. (So does my father). The bags aren't always as puffy. I massage away the puffiness daily & rinse my eyes out with water which helps but nothing helps that deep line. I'm 31 but people guess much older. What would you recommend for a permenant fix? I'd like a procedure before my birthday this September.

Doctor Answers 6

I need advise on my tear trough deformity.

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I would suggest hyaluronic acid fillers to restore the volume of the crease which will give a nice smoothing appearance without surgery. The beauty is it can be performed in the office with minimal if any recovery and dissolved within a day or so if you do not like the results.

Fort Wayne Plastic Surgeon
5.0 out of 5 stars 13 reviews

Try some fillers

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I see the crease you are talking about, and it isn't a typical tear trough deformity.  With a typical tear trough, there is thin transparent, dark skin under the eye that has a marked change when it crosses over to the cheek.  You have good volume and skin tone and thickness in both your lower lid and cheek.  You have a bit of puffiness when you just woke up (very typical for all of us) and on your other pictures you appear to have a crease across your lower lid/upper cheek junction.  I would do a temporary fix (a year or so) with fillers.  That way you can see if you like it and you haven't done anything irreversible.  If you do like the effect, you could have a longer lasting (or even permanent) filler placed, or fat grafted into the area.  
The down side of permanent fillers is that as your face ages, they might not be in the right spot anymore - so they can backfire if done poorly.  They are really only good for deep, structural corrections as opposed to soft tissue contour issues like yours.  Hope this helps!

M. Renee Jespersen, MD
Fairfax Plastic Surgeon
5.0 out of 5 stars 7 reviews

I think you will be in trouble getting a permanent fix.

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This issue is best managed with hyaluronic acid fillers.  Treatment lasts approximately one year and then needs to be topped off.  You need a very experienced injector for this service.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Tear trough deformity

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You do have a tear trough deformity but you also have a prominent malar crease. The malar crease runs diagonally from the tear trough towards the lower face. 
Surgery to correct the tear trough involves an incision inside the lower eyelid and re-positioning the fat from inside the eye socket to over the rim of the eye socket. This provides the volume needed to correct a tear trough deformity much like a filler would, but the fat does not dissolve like a filler will. It is about as permanent as you can get for this problem. 
The malar crease is formed by a tight ligament that runs from the skin down deep to the cheek bone. Correcting this is more involved and requires division of that ligament and re-positioning of the cheek fat pads. This can also be done through an incision on the inside of the lower eyelid. This is what is usually referred to as a midface lift. 
Fillers would be your non-surgical solution but I would caution you about this option as fillers can sometimes worsen the appearance of the malar mounds (cheek bags) by causing prolonged edema. 
I recommend you discuss your concerns with a surgeon experienced in eye and midface rejuvenation. 
Best of luck. 

Bradford A. Bader, MD
Plano Facial Plastic Surgeon
5.0 out of 5 stars 9 reviews

Lower lid bags

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There is no such thing as a permanent fix.  Some filler such as Restylane into the tear trough will last at least a year.  For a longer term solution you could do a lower lid blepharoplasty with fat repositioning.  You also have a prominent malar fat pad and you can see the edge of this lower on the cheek.  The fat pad will need to be addressed at the same time to try and smooth out the lower lid.  

John J. Martin, Jr., MD
Coral Gables Oculoplastic Surgeon
5.0 out of 5 stars 31 reviews


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It appears you have prominent fat in your lower lids.Specifically the middle and medial compartments.The fat needs to be addressed in those aforementioned areas and some augmentation of the trough would be advisable as well.

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