I'm losing volume under my eyes.

Tear troughs are universal to some degree. Puffy lower eyelids can make them worse by protruding anterior to the tear troughs. This causes a shadowing effect and the so called "dark circles" that make us look more tired or older than we are. The puffy lower eyelids combined with a loss of cheek fullness, due to descent of the cheek fat pads (malar fat pads) further accentuates the tear troughs. While fillers are often recommended for these tear troughs, they are not without risks and are certainly not the only solution. Sometimes seemingly more aggressive procedures are actually less risky, and much more effective and permanent than fillers. Transfer of the puffy fat pads of the lower eyelid under the depressed tear troughs gives a very aesthetic contour of the lower eyelid/cheek region and in the right hands, can give a safer, more permanent correction. Reduction of the puffy eyelids, will give a less tired look, while filling the tear trough, will give a more youthful contour of the eyelid, cheek junction with minimum risk or down time. Be sure to get all of the facts before you decide on the best treatment for your situation.  John Standefer MD

Hi realr29.  The transition between your lower eyelid and your cheek can be treated multiple ways.  Filling volume in the cheek with Juvederm Voluma or Restylane Lift will provide support to the lower lid, while improving the tear trough area.  Fillers that can be placed directly into the tear trough all include off label applications, driven mostly by their smooth consistency with little tendency to swell (Juvederm volbella, restylane silk, belotero) and platelet rich plasma gel that is prepared from your own blood.  An expert injector will recommend the correct product based upon your anatomy & skin.  Best wishes,

Please see the following for all the options for adding volume in the tear trough area. There are both nonsurgical and surgical options available, each with pros and cons. See an oculoplastic specialist.