Volume deficient tear troughs combined with sunken eyes. What's the best way to fix for a 21 year old female? (Photo)

I have deep set eyes, with tear troughs. I'm 21 and I've had this problem since I can remember (childhood picture attached), so I don't think it's age related volume loss. With my sunken eyes and tear troughs, I look very tired/sad and I would like to alter this somehow. I've read about tear trough implants/ tear trough fillers, and I was wondering what may be a good option for me. I'm very open to other ideas besides only those that address the tear trough area, so please let me know.

Doctor Answers 5


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A hyaluronic acid filler would be a great solution.  I would never recommend a tear trough implant.  Filler is going to look natural and can be put precisely where you need it.

Bellevue Facial Plastic Surgeon
5.0 out of 5 stars 17 reviews

Treatment of tear troughs and hollow eyes

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The presence of hollow eyes and tear troughs is usually inherited and does not reflect any aging.  

In my opinion, the best treatment would be with a skin filler such as Restylane.  These fillers will usually hold up for 1-2 years and can then be repeated or touched up as needed.  Would not use a tear trough implant -- ever!! In fact, there is no operation that would work for you for this particular problem.

You will need an expert injector because the skin and other tissues are thin in this area.

One nice and reassuring point:  there is an antidote for Restylane (and any other hyaluronic acid filler) -- so if you don't like it, it can be neutralized.

Do your research carefully and find a board certified plastic surgeon who is skilled at these injections.

Good luck!

Elliot W. Jacobs, MD, FACS
New York City

I strongly advise against a tear trough implant.

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Hands down, the best treatment for your issues is under eye filler.  The key is finding a highly talented injector to treat this area.  Less is more.  You have very thin skin here.  That is one of the reasons that a tear trough implant is not idea.  However, having a small amount of filler in the under eye area will provide a cushion of volume in the tear trough area.  It is important to understand that you are being sculpted.  That means you need to go to an artistic injecting physician.  Unfortunately, they are not all artists.  So that means doing your homework.  Restylane is the best product for this and treatment is likely to be effective for more than a year.

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

Sunken eyes

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A filler can help with the tear trough, but I wouldn't worry about the "sunken eyes"  this is a normal variant abd looks good on you.  There is no easy way to surgically alter it, and I would caution against attempting to do so

Reps B. Sundin, MD
Washington DC Plastic Surgeon
5.0 out of 5 stars 32 reviews

Under eye area dark circle treatment

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Dark circles can be present at a young age. Cosmetic treatment may consist of facial filler, such as Restylane to help add volume and reduce appearance of the dark under eye circle. Most plastic surgeons will avoid an eye or tear trough implant. Instead, office filler injection can provide adequate improvement. Fat injections are an alternative for some patients. For younger patients like yourself, office treatments are usually adequate. If you haven't already, then speak with a plastic surgeon to help determine appropriate options for you.

Dr. Chaboki

Houtan Chaboki, MD
Washington DC Facial Plastic Surgeon
4.9 out of 5 stars 89 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.