What permanent solutions are out there for this deep tear trough under my eye? (Photos)

Based on your photos, you are a good candidate for eyelid surgery. It is difficult to tell the size of your fat bags under the eyes in the photos. But you can't really operate on puffy morning eyes. The fat would have to be present all day and you don't want the fat to be over resected because you will look more hollow. You appear to have some malar edema which is difficult to treat. Along with conservative fat removal, a fat transfer should also be done to hide the orbital rim and make the edema and tear trough less noticeable. Be sure to see a facial specialist for consultation.

Hope this finds you well. When done correctly under eye filler can last quite a while (18 months+), for a longer lasting option consider fat transfer. Best of luck.

The best solution for you would be a lower blepharoplasty with fat transposition. The fat from the orbital region is transferred into the hollow to make it look more normal.

Best Wishes,

Gary Horndeski, M.D.

2 potential treatment options are filler injection and infraorbital rim implant. Need more detailed evaluation and discussion with expert to determine what is best for you.

You seem to be a good candidate for transconjuctival lower blepharoplasty to correct tear through deformity and ad volume to the upper cheeks by means of fat grafting. In person consultation or a teleconference with a board certified plastic surgeon with experience in these techniques is recommended. Good luck.

This area is complex both in regards to making equality assessment and in regards to treatment.
Fundamentally issues in this area are primarily determined by bone structure.
Soft tissue coverage tends to be fairly consistent from person to person.
Individuals pretend to develop the concerns you describe Often have a slight lack of projection, skeletal structure there midface or Maxilla.
Midface volume enhancement can be done using fillers, fat grafting, augmenting with an implant or a midface lift. All of these treatments have certain advantages and disadvantages.
Quality outcomes is heavily based on provider selection.
Simply pink port certified in plastic surgery with a good reputation may be insufficient when it comes to finding the right provider for this kind of work.
There are usually two contour changes that often happen simultaneously with age.
In a youthful face, the contour of the lower eyelid should be tight and snug.
They are just below. The upper part of the midface should be full and plump.
This is typically what we see in young individuals.
As we age, the two contours reverse.
The fat pads deep to the lower eyelid begin to protrude, causing fullness in the lower eyelid.
At the same time volume in the upper midface begins to disappear or droop.
It can be helpful to first assess whether fullness in the lower eyelid is the primary problem or lack of volume in the tear trough or upper mid phase is primary. often it’s a combination of both.
sometimes correctly applied volume enhancement in the midface, using fillers, can potentially Elim or minimize the appearance of lower eyelid, fat pad bulging.
In my opinion, this anatomic region is by its nature complex and difficult to treat, especially when it comes to delivering consistent high-quality outcomes.
For that reason, there are often differences in approach or surgical treatment recommendation.
I recommend you look up the website of Dr. David Mabrie, MD in San Francisco.Real self does not let me include links to other websites so you’ll need to Google his name. David is a facial plastic surgeon who is devoted his career to facial volume enhancement using fillers only.
He has an impressive collection of quality before and after pictures on his website.
His work is the best I’ve ever seen when it comes to Facial enhancement using fillers only. I’m not suggesting people fly to San Francisco to get fillers. I think seeing his results conserve as an educational tool to understand what can be achieved to using only fillers in the hands of the right provider.
Once patient know what quality results can look like they can use this in their their decisions when it comes to choosing local providers.
In regards to lower eyelid surgery, I generally stay away from removing skin or trying to tighten up the lower eyelid.Removing skin and orbicuaris muscle from the lower eyelid seems to lead to a premature ectropion too often.
In the end, provider selection is probably more important than what procedure you choose.
I cannot emphasize enough the importance of thoroughly vetting providers for permanent irreversible surgical intervention in this relatively challenging anatomicBest,
Mats Hagstrom MD