Indented Undereye Lines - Is This Due to Fat Loss?

I am 43 and this started appearing about a year ago. The indented lines are underneath the eye area and run down to my cheek in the form of a long curved line. I was told that this was due to fat loss in this area (I have no bags). Fillers were recommended. If I stretch my skin slightly from the temples, the indents do not look as bad, but I was told I was not a candidate for a 'slight' face lift? What causes this? Is it fat loss or could it be a loss of nutrients? Topical recommendations?

Doctor Answers 2

Treatment of tear troughs

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In the young individual the transition between lower eyelid and cheek is imperceptible. The dividing line between these areas in older individuals is the nasojugal crease also called the nasojugal groove or tear trough). It is an early sign of aging around the eyes, lending a fatigued and aged appearance to the face. As part of the aging process ligaments that fix facial skin to the underlying facial bones thin and lengthen or stretch, facial bones recede back and facial fat shrinks. This results in the drooping of facial skin and appearance of laugh lines, jowls, nasojugal creases, eyelid bags etc.. The skin within the nasojugal groove or crease becomes thinner and/or darker in color than the slightly lower nose or cheek skin. It can also seem deeper or be more visible if there is protrusion of fat into the lower eyelid. The aging process starts near the nose as the tear trough and progresses outwardly towards the same side ear becoming what is called the palpebromalar groove. A facelift alone will not usually fill these grooves under the eyes.

Los Angeles Plastic Surgeon

Injectable Fillers may be used to improve lower eyelid grooves that extend down to your cheeks.

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I read your concern. It sounds like you're describing typical lower eyelid grooves that can extend down into a curved midface depression. This is due to age-related loss of fat.

In my practice, these grooves and depressions are improved with Silikon-1000, an off-label filler, for permanent results.

I've attached a photo from my RealSelf gallery of one of my gracious patients with eyelid grooves that descend into midface depressions. She was treated with Silikon-1000 with topical anesthetic.

I hope this is helpful for you.

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 435 reviews

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