How to get rid of deep tear troughs & dark eyelid pigmentation?
Doctor Answers 8
Lower Eyelid (Orbital) Hollowing. The less the lower eyelid skin is "inflated" the darker it looks.
You have deep set eyes which are both a blessing and a curse. The blessing part is that it is an exotic eye with a lot of eyelid showing and some of the most attractive eyes around. The curse part is that there is darkness just above and below the eyelash line. Actual dark pigmentation of the skin is very hard to treat, because the goal is to actually reduce the amount of melanin in the skin. There is another type of darkness of skin is when the skin is bunching. Imagine your knuckle skin or elbow skin when your fingers or arms are straight. Because the skin is bunching the skin looks darker. If the skin is stretched, then the skin looks lighter.
During consultations, I will request the patient bring younger photos of when they thought they looked better. It may be possible to diagnose the problem which caused your eyes to become "dramatically worse" over the years. By that reasoning, your eyes were "dramatically better" when you were younger. I would want to see clear photos of what your eyes looked like at the time.
I would like to define what tear troughs are, before proceeding with the discussion. The tear troughs are a diagonal linear groove that starts from the inner corner of the eye and goes diagonally about 45 degrees in a straight line towards the center of the cheek. The groove which is dark on your photos is hugging your eyeball and parallel to your eyelash line. This deep groove is not a tear trough and is not what we normally fill when we are discussing tear trough filler. If we look at your tear trough, is not a deep groove at all. You actually have a small convexity of fat which surgeons diagnose as pseudoheriation of lower eyelid fat, which is between the lower eyelid groove and the tear trough. Filling the tear trough will at least hide the pseudoherniated fat to the lower eyelid groove. To remove any fat using a transconjunctival lower blepharoplasty will only hollow your lower eyelids out even more and make the area even darker.
Your lower eyelids remind me of a website which I encountered over the years from a Dr. Meronk. He describes an epidemic of post-blepharoplasty hollowing after lower eyelid surgery. He developed a technique of replacing the lower eyelid fat. He has since retired, but I think his theories are really interesting.
I will include a link to his informational website, but remember he is already retired. Scroll to the very bottom of the post and look at the last before and after of the Southeast Asian patient with similar lower eyelids to yours. I suspect that diagnosis is loss of lower orbital (eye socket) fat. Note in the before photo, that the patient has a moderate lower eyelid groove (not tear trough), and on the after , the lower eyelid has no groove and is straight down. Note the outer part of the lower eyelid is better supported and flatter, as well as covers a small portion of the lower iris (colored part of the eye.) In his example, I think this person had spontaneous fat loss and was not caused by lower eyelid fat removal surgery. If you look at all of the examples, you can see that the problems is similar to the lower eyelid fat removal hollowing.
This may be a genetic thing for Southeast Asian people. For East Asian people, we have a surplus of fat around our eyes and you don't really see darkness around East Asian eyes. In fact it is actually very bright skin. If you look for the same deep lower eyelid groove (not tear trough) on a Google image search of Asian eyes, it will be very hard to find it (unless they had lower eyelid surgery.)
For ethnicities, that commonly have dark circles around their eyes, their bone structure is different. Typically the cheek bone is weaker, and they have something called a "negative vector eye" which means the eyeball is protruding past the cheekbone. This causes the lower half of the eyeball to be exposed and the lower eyelid is essentially hugging the bottom curvature of the eyeball. The more hollow they are, the more lower eyelid is "hugging" the eyeball. Perhaps, in youth your lower eyelid was not hugging at all or perhaps only 1/8" which is acceptable. Once it starts hugging about 1/4" or longer, then the darkness really starts to become noticeable. Another observation is that a deep wrinkle will form between the hugging portion of the lower eyelid and the remainder of the lower eyelid skin.
I have applied Dr. Meronk's upper eyelid techniques since 2006, and only recently started applying the lower eyelid techniques for fear of creating eyebags. Since I am only in the early stages of using the technique, I wait a while before I give ruther thoughts on it. You can see for yourself, what Dr. Meronk was doing, and I think he was ahead of his time.
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Deep tear troughs and dark eyelid pigmentation
1. Shadowing from congenital or acquired (via bone and fat resorption as we age) volume deficits
2. Rubbing the eyes, for example, if one has allergic conjunctivitis or atopic or contact dermatitis, which can cause the skin to hyperpigment
3. Thin skin, usually from aging and/or sun exposure, which allows the tiny blood vessels to show through
4. A defective orbital septum, which allows fat to protrude and therefore creates a shadow
5. Excessive stremgth of the medial fibers, nearest the eye, of the periorbital muscle, such that when one smiles, a shadow is created from the bunched-up fibers.
Only an in-person evaluation can determine which factors are operative in your case, but each can be treated successfully. If the first cause is part or all of the problem, Restylane or Beletero (rather than Juvederm) may help. The second and third factors can be treated with topical retinoids and antinflammatories, and addressing any allergies or irritants. The fourth factor is best treated through plastic surgery, although I have seen patients who do not wish to have surgery improve with dermal fillers. The last factor can be mediated with just 2 to 4 units of Botox.
Based upon your photo only, you may have the first, second and fifth factors contributing to your problem.
I hope this is helpful to you. If you have any further questions, please let me know.
All the best! Dr. Clark
Tear trough treatment
Tear-troughs are a major factor causing dark circles under the eyes because they fall into shadows. Filling out the tear-trough prevents the shadow and reshapes the area so that the opposite occurs, light catches the area and makes it a bright area.
There are 3 basic treatments for tear-troughs
1) Temporary injectable fillers like Restylane. These work quite well for mild tear-troughs and help with moderate ones. Severe tear-troughs are usually not treated this way. The advantages are the ease and lower cost. Most often there is no bruising and a few days of swelling. It is done during an office visit. I like to use 1/2 cc on each side and after one month consider adding an additional 1/2 cc if necessary. The disadvantages are that it is not permanent. Risks include lumps or excess puffiness. The product can be dissolved if you don't like it.
2) Fat transfer. Fat transfer is similar to injectable fillers in that it is a soft tissue filler. It is much more costly than injectable fillers, is a surgical procedure usually done with sedation, and requires a fat donor site. It has the benefit of possibly being long lasting. Disadvantages include the fact that often times the fat fails to survive the transfer and dissolves in a few months. It is also problematic to correct if it were uneven or otherwise un-attractive. Like Restylane, large amounts of soft tissue fill will crowd when you smile or squint.
3) Tear-Trough Implants. This is my personal approach for moderate to severe tear-troughs. It is a surgical procedure and requires anesthesia (deep sedation) and there will be swelling and bruising. It is cost effective as compared with Restylane when you consider a time frame of 5 or 10 years of injections. It is always permanent but it is also removable. It is "scar free" since the incision is on the backside of the eyelid. It is not a soft tissue filler so more augmentation is possible without looking puffy. It can be further refined with Restylane of fat transfer over the top of it if so desired, though this is usually not needed. Complications include movement of the implant in the first days after surgery requiring re-positioning. Once healed, they can not move.
Regarding dark pigment. Unfortunately there aren't any highly successful ways to treat this. Bleaching creams like hydroquinone may help lighten melanin pigmentation. If the problem is more vascular/fluid related then treating allergies, fluid retention issues, thyroid issues, or other medical problems may help. Sometimes hormonal issues can contribute to the problem. Often times, however, it comes back to makeup.
Correcting tear troughs
Pigmentation around the eyes
Softening Tear Troughs and Blending Pigment
This combination will rejuvenate your midface, and give a more rested appearance.
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.