What can I do to minimize the appearance of deep tear troughs? (photo)

A deep tear trough is due in part to a very adherent orbicularis oculi muscle medically and in let due to a relative deficiency of fat in that area. Fat transfer with or without a transconjuctival lower blepharoplasty approach to lift the muscle off the
bone can reliably improve a pronounced tear trough. A brow lift or midface lift will not arsenide areas and filler tends to leave ridges and is temporary.

Sorry that you have spent so much time and money and experienced such frustration on the treatments you have already had. At least from the one front face photo provided there appears to be significant volume deficit in the cheeks that has not been addressed and is contributing significantly to the apparent loss of the overall more ideal feminine heart-shaped, oval face, but which is also contributing to the lack of support for the infraorbital region that is largely responsible for the appearance of the under-eye hollows and tear troughs. A properly injected, appropriately robust HA volumizing filler for the upper cheeks will likely significantly achieve both of the aforementioned goals. You would be wise to make sure that you are consulting with an experienced, board certified cosmetic dermatologist filler expert. Hope this helps. Best of luck and Happy New Year.

Dear doodlebop,
The tear trough deformity can be a challenging problem. We don't have your full history, such as did you have your lower lids operated on. Fillers, or fat transfer are the usual solutions. The area, as you may know, is very sensitive and there are risks that should be discussed with your surgeon. Good luck!