I've had tear troughs since birth so I assume they come from genetics. (photos)

Question

By looking at them, what can you see that can be done? How risky are surgical procedures for tear troughs? What is the average cost for both a filler and surgical procedure, from supremely educated and succesful practitioner?

Yannis Alexandrides, MD, FACS · Answer

I   believe you would be a good candidate for fillers. This can improve the under   eye hollowness, but it's difficult to give definitive advise without seeing   you for an in-person consultation. It may be that you also have festoons   which are another problem. Seeing your face from all angles will help to   determine the best course of action. . For a more natural approach you could try the 111SKIN Celestial black diamond eye cream which will help to reduce fine lines around the area as well as puffiness and dark circles.

A.J. Amadi, MD · Answer

Both tear trough fillers (Restylane is my preferred choice in this area) and lower blepharoplasty are good options, so make sure you choose a surgeon that is experienced in both these techniques to give your the pros and cons of each. In my opinion, although fillers can be very helpful in this problem, lower blepharoplasty with fat repositioning is the most natural long term result which will give you the result you need without making you look too different. Fillers can camouflage the problem nicely, but come sometimes lead to some edema (swelling). Also some injectors can be too aggressive with the fillers and add too much volume to the upper cheek, leaving you with the tell-tale sign of "overdone eyes and cheeks".At your young age, you likely don't need a lot of volume addition, but rather reposition the fat from the bulge to the hollow area underneath. If you go the "Eye Bags" photo section in my profile you will see a few examples of repositioning in younger patients. I've posted one of the below.

Elham Jafari, MD · Answer

Hi and thank you for posting your question here! As
I see in the picture you posted, I do not think you need any surgical
procedures. You can get complete correction with injection of fillers under the
eyes. You have several options such as Belotero, Volbella or Restylane.
I highly recommend doing the injection using a cannula which can help
achieving very natural results while leaving minimal bruising or swelling. It
is a quick procedure when performed by a well experienced physician and there
is none to minimal down time. I hope it helps and good luck!

Sam Naficy, MD, FACS · Answer

Based on your photos you have a combination of fat prolapse (lower eyelid bags) and volume deficiency of the tear trough.  There are a number of options for you including injectable fillers, lower blepharoplasty, and fat grafting.

Cameron Chesnut, MD, FAAD, FACMS · Answer

Tear troughs have a relatively complex anatomic foundation, and that varies from person to person depending on the structure of bone prominence, fat pads and muscular attachments. 
Surgery in this area is completely dependent on your underlying anatomy. For example, if your cheekbone is underprojected, the surgical requirements are entirely different than with a full cheek sitting below.
Volume in this area with fillers can be an excellent option in situations like yours.
To ensure you are receiving the highest level of care, seek out a modernly trained, new-school dermatologic surgeon, oculoplastic surgeon, facial plastic surgeon or plastic surgeon who is board certified and fellowship trained in one of these "core four" cosmetic specialties.
Cameron Chesnut#realself500 Physician

Philip K. Robb Jr., MD, FACS · Answer

Hello and thanks for your question. 
You're eye's look very pretty- I do see what you're talking about.  Here's my .02$- you look young... 
There can be medical causes of this appearance- those need to be ruled out. If it's simply deep tear troughs- this is a result of where the bone lining attaches to the skin and pulls it toward the bone... 
The cause of this problem is fixed with a short surgical procedure. It's permanent and is proven to work. I normally use fillers for two reasons: 1. a patient doesn't want surgery. 2. to "try it on" and to see what results could look like after surgery.
You could do nonsurgical (PRP, lasers, fillers etc) - this will have to be repeated every 1-2yrs and can run 800-3K per treatment depending on what's done.

Hope this helps and God Bless!

Dr. Robb

Jason Emer, MD · Answer

Yes, these are genetic and a combination approach is needed to get improvement. Fillers, lasers, and microneedling/PRP can improve under eye bags and hollows. My patients try to get non surgical treatments to avoid surgery. We use PRP and stem cells there often. Cost will vary. I suggest consulting with an expert to develop a treatment plan best suited for your short and long term goals. Best, Dr. Emer.

Ivan Vrcek, MD, FACS · Answer

Thank you for your question and picture. 
In younger patients with volume loss in the eye region, I typically recommend hyaluronic acid gel fillers like Restylane and Juvederm. Judging by your photo, this would be a good option for your particular anatomy. Consider finding an experienced oculoplastic surgeon in your area. Best of luck!

Daniel J. Ritacca, MD · Answer

Thank you for your question. In my practice I often use Restylane injectable filler to improve under eye hollowness and volume loss in younger patients. I would recommend an in person consultation with an experienced injector to determine candidacy which is key in providing a safe and natural looking outcome. I hope this helps. Best wishes.

Camille Cash, MD · Answer

You may want to begin with conservative non surgical approaches.  Fillers do a nice job of adding volume to hollow areas to give a smoother overall appearance.  Lasers, chemical peels and microneedling (Skin Pen) can improve quality and texture of the under eye area.  I recommend visiting with an experienced board certified plastic surgeon for a consultation to determine which procedures are best for you.

I've had tear troughs since birth so I assume they come from genetics. (photos)

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