What procedure is recommended for my deep tear troughs, hollow sunken eyes and malar bags? (photos)

Question

I am considering tear trough fillers but not sure if that will be enough or even work

Nelson Lee Novick, MD · Answer

From the photos provided, there appears to be rather significant under eye hollowing and tear trough formation. In cases such as this, the use of an appropriately robust volumizing filler, such as Voluma XC or Stylage XXL, injected directly over the lateral cheekbone regions would likely help to improve both the hollows under the eyes, as well as the tear troughs. Should any additional improvement be desired or needed, a small amount of a cohesive filler, such as Belotero Balance or Teosyal Redesnity II could provide additional improvement and further help to create a smoother transition between the upper cheeks and the infraorbital regions. This is not a region to be left to the hands of novice injectors accustomed to using simple Restylane or plain Juvederm to plump smile lines. What is required here are advanced injection skills. So, make sure that you consult with a board certified aesthetic physician and make sure to ask to see his/her personal before and after photos before agreeing to proceed. Best of luck.

Jason Emer, MD · Answer

At home peels like cosmelan, enlighten and aerify along with dermarolling (MTS roller with anteage MD ampules) should be started now. There are many things you can do to treat under eye hollows and dark circles. A surgical option to remove skin and/or fat will such as lower eyelid blepharoplasty with or without fat pad repositioning will be the best long term. There are many things you can do to treat under eye hollows and dark circles without surgery. Non invasive less downtime options such as fillers (Belotero, Juvederm Volbella​), lasers (Moxi/Halo/Fraxel/CO2​), Renuvion (J-Plasma), microneedling/PRP, stem cells and microneedling RF like Fractora PiXel8 or Morpheus can all help give some improvement. Accutite can often be used or stronger lasers like erbium or co2 spot treatment can tighten the skin and give very quick improvement in wrinkles and texture. A surgical option to remove skin and/or fat might be the best solution long-term. I suggest you get a formal consultation to see what is best for you and your goals. Best, Dr. Emer.

Nima Shemirani, MD · Answer

Hi @agarcia882020! You would be a great candidate for tear trough fillers. The upper cheek is a major support for the under eyes. I would first begin with addressing the volume loss in the cheeks followed by addressing the tear trough area.  Best of luck, Dr. Nima!

Ronald J. Edelson, MD · Answer

I have never bought into the notion of the tear trough. Many patients get themselves talked into fat transfer for this. I’ve never seen a good result but I’ve seen plenty of patients develop lumps in their lower lids. In your case removal of the excess fat is what is needed, although it is really not even that bad in your case.

Jonathan Kulbersh, MD · Answer

Based on your photos, it appears you would be a good candidate for tear trough fillers. This nonsurgical treatment places small amounts of dermal filler into the area under the eye, adding subtle fullness and reducing discoloration. I typically perform this procedure using a blunt-tipped micro-cannula to ensure the smoothest result and reduce the risk of side effects like bruising and swelling. Make sure the injector you choose has the experience, training, and expertise to provide you with the most natural results.

Philip S. Schoenfeld, MD, FACS · Answer

You appear to be relatively young and therefore have maintained a decent amount of volume in the cheeks and mid face area.  If this is the case then a single syringe of Restylane should be enough to address the problem.  If there is also medial cheek deficiency then another syringe of perhaps Juvederm Voluma, Radiesse, or Restylane Lyft will help support the lower eyelid at the lid cheek junction when placed appropriately.

Jennifer Thomas-Goering, DO, MBA · Answer

Thank you for asking this question! There are many people that suffer with this condition. One common way to address this problem is to fill the area with filler like Boletero Balance or Restylane. However, the really solve the problem rather than cover it up is to use a high quality, dual spin PRP injection into this area. It not only will improve the dark circles but it actually will improve the skin and texture in the area by stimulating collagen. This is also a safer procedure than placing filler in this area. There are many dangerous structures like arteries and lymphatics that can cause a poor outcome. The key to getting good results is to find a provider that uses verified dual spin PRP. All the medical research requires that for the best results you need to make sure that you are using 5-7 x concentrated platelet rich plasma. There are many providers that use weaker concentrations and you may not get the results that you want. Be sure to ask questions regarding the PRP system that they are using. You will get great and natural results with this treatment with decreased complications and risks from placing filler in the area.

Ed Breazeale, Jr., MD · Answer

Hello and thank you for your question. From the pictures, it seems you would be a great candidate to get fillers in the tear trough area. Both restylane and juvederm products are great. This will help with the hollowness of your eyes. As your prepare for your consultation/injections, make sure to avoid products like alcohol, NSAIDS, fish oil, and other products that can thin your blood to help avoid bruising. Also be prepared to swell in that area after injections if you decide to move forward with it. It is very important to get an experienced injector!  Good luck to you!

Robert T. Buchanan, MD (retired) · Answer

You appear to be a perfect candidate for filler. You have a double orbital ligament with one extending down your cheek and the other (lateral) along the orbital rim. The filler needs to be heavy like Juvederm Voluma and placed under the ligament. Make sure you choose an expert in this area, as the wrong filler in the wrong place can actually make things worse.

What procedure is recommended for my deep tear troughs, hollow sunken eyes and malar bags? (photos)

Answers (9)

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