Are Injections My Best Bet for Hollow Tear Troughs? (photo)

I'm 20 years old but I feel like my eyes look like that of a 50 year old. I've been pretty self-conscious about them my whole life, so I usually cover up it up with concealer and wear eyeliner and mascara. My eyes have really deep tear troughs, and then I have the folds of skin under each eye. What causes this? Is this a result of my tear trough deformity? Would getting a filler help with these, too, or accentuate them more? Would I be able to get by with only one or two treatments?

Doctor Answers 6

Injections for hollowness under the eyes

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Your problem is the infraorbital rim (the bony rim under your lower eyelid) does not project enough. It is behind the front of your eyeball. Injections of Restylane, Juvederm, or Sculptra would definitely be a big help for you. However, you would need the injections repeated every year or so, and at the age of twenty I would strongly consider a tear trough silicone implant. This should be done by a surgeon certified by the American Board of Plastic Surgery and someone who has experience with this procedure. This can be a life changing procedure, and it will last a life time.

Treatment for tear troughs

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It is best to see someone in person for a consultation to discuss what bothers you about your periocular appearance and to discuss what results you are looking for.  That being said, it looks like you would benefit from filler injection.  I like to use Restylane in this area.  The results can last for about a year and can be done in the office in a matter of minutes. You want to see someone who is skilled in doing this especially in the periocular area.  


Keshini Parbhu, MD
Orlando Oculoplastic Surgeon

Treatment options for hollow tear troughs

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   The tear trough is probably one of the most challenging areas to treat. You really need to have a detailed in person evaluation by an experienced surgeon as small judgment errors in technique can lead to a lifetime of dissatisfaction. There are so many factors that go in to the decision making by a surgeon. Some things to consider are the relative position of the eye globe to the rim of the cheek bone, the position of the cheek mound, the thickness of your lower lid skin, real or pseudo-herniation of the fat pads surrounding the eye.  While filler is a good option for some, there are very good surgical techniques that can spare the integrity of the lower eyelid and blend the cheek lid junction. 

Joseph Shvidler, MD
Tacoma Facial Plastic Surgeon

There is no substitute for an actual in person consultation.

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However base on this photograph, I would discourage you from letting anyone do lower eyelid surgery.  That is not what you need.  Filler is what you need.  Please be aware that this service is a bit of an art form.  You really need to find someone who is quite good and very experienced in this service but the results are fantastic.  Treatment with Restylane, once you get enough volume, can last well over a year.

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

Lower Eyelid Grooves - Treatment Options

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Lower eyelid grooves, also called tear troughs, can be nicely improved with fillers.  There are several fillers that work nicely for this and which are considered safe and effective.  As is the case with any filler treatment where you are injecting a material into the skin with a needle on a syringe, risks include bruising, bleeding and swelling all of which resolve within 5 to 10 days.  It appears from the picture that you have mild tear trough creases and would likely benefit from having them filled conservatively.  If there is also fullness above or beneath the creases (difficult to assess from this picture, likely related to fat pad herniation), that may require surgical removal with a procedure known as a blepharoplasty.  However, I have found often even when fat pads are present with the tear troughs, if you correct the tear trough creases with a filler, it tends to blend out the fat pads making them less noticeable and avoiding the need for further treatment.  Typically, the cause of both tear trough creases and fat pad herniation is related to one's genetics and one's age.  Given you are very young, in your case, it is most likely your genetics kicking in.  I recommend you consult with a board-certified dermatologist or facial plastic surgeon for an evaluation and discussion of treatment options. 

Channing R. Barnett, MD
Boca Raton Dermatologist
4.1 out of 5 stars 8 reviews

Question regarding under eye bags or tear troughs

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Tear troughs can be treated easily with injection with hyaluronic acid.  In my practice I generally use resylane fine lines for under eye tear trough correction.  Typically one vial  per side is adequate. In certain situations more is required.  This is an office procedure which takes minutes to do.  Mild bruising can occur.  Fat grafting and blepharoplasty are also options to treat aging eyes with tear troughs.  Surgical correction is typically required in patients who have tear troughs with associalted fat pad herniation. 

Philip Solomon, MD, FRCS
Toronto Facial Plastic Surgeon
4.4 out of 5 stars 118 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.