Terrible Tear troughs. (photos)

I'm 45 and look exhausted and terrible all the time because of my hollow under eye area. I'm hydrated and well-rested. I always had a purplish slash under my eyes even as a teen but now it's just so bad. No amount of make up helps. The filler reviews terrify me especially since my skin is thin there and I assume the purplish slash means i have blood vessels close to the surface. Best advice?

Doctor Answers 7

Lower Eyelid Bags-Treatment

Thank you for your question and photos.  After reviewing your pictures I would suggest either filler to improve the contour of the lower eyelids or a lower eyelid blepharopalsty.  Either of these would give you a natural look and improve the appearance of your lower lids.  I would suggest a complete examination with an oculplastic surgeon to discuss your treatment goals.  A surgical approach would be a more permanent solution, but I would suggest a conversation with an experienced surgeon to learn more about each procedure.


New York Oculoplastic Surgeon
5.0 out of 5 stars 27 reviews

Improving tear troughs and discoloration

From the photos it looks like there are several issues that need to be addressed to improve the under eye area/tear trough but you need a consultation with an injection specialist to review your options.  Most likely a long lasting injectable such as Voluma or Radiesse may be helpful in the midface to improve the contour and peels or IPL laser may be needed for the discoloration.  Sometimes filler such as Restylane (off label) directly on the bony area around the eye is also needed.  If possible, seek out an oculoplastic surgeon who is also an injection specialist and review the options.  This appears to be a common condition that can be treated and greatly improved by an experienced physician/surgeon.

Joseph A. Eviatar, MD, FACS
New York Oculoplastic Surgeon
4.7 out of 5 stars 64 reviews

Terrible Tear Troughs

Hi Jenh56!Thank you for sharing your photos and question. You are correct that deep tear troughs make you look tired when you are not, and that this is thin skin with blood vessels. It can be readily improved using fillers like Restylane, Belotero, or Voluma, which provide the simplest, lowest risk and lowest cost solution. The likelihood of problem is low with an experienced injector, and these products are all dissolvable, so in the unlikely event of an issue, the product can be easily dissolved. The safety margin can be further improved if your injector is experienced with the use of a blunt tipped cannula in the tear trough area. This cannula does not have a sharp point, so is glides past the nerves and blood vessels, dramatically reducing the probability of bruising. In addition, when we perform this procedure, a thin shelf of filler separates the skin from the underlying vascular network and usually dramatically reduces the purple color problem. Good luck!

Recommend consultation

I highly recommend a consultation with an experienced facial plastic surgeon well versed in fillers as well as lower eyelid surgery.  If you want a more long-lasting result with about 7-10 days of downtime, I recommend a lower eyelid surgery otherwise you can try fillers which have less downtime but are temporary. 
Wish you the best!!

Babar Sultan, MD
Towson Facial Plastic Surgeon
5.0 out of 5 stars 6 reviews

Tear trough

Thank you for posting your pictures. From what I can see on the picture, your main issue is what is called tear trough deformity. You also have minor lower eyelid bag protrusion and full upper eyelids. Correction of the tear trough will improve your eyelids and periorbital area the most. Fillers like Belotero in this area will give you great results. The fillers will last 6-9 months, and you will need to have the tear trough injected again at that time. If you are willing to have surgery, then you can have results that are more permanent. This will entail a lower blepharoplasty with fat transposition to the tear trough area. If you wish, a small amount of skin can also be resected from your upper eyelids which will make your eyes look more refreshed. Make sure you find a surgeon with experience in eyelid surgery and fillers in the periorbital area since this area more than anywhere else requires of special knowledge and technique to give you a good result.  Hope this was helpful. Good luck!

Tear Trough

Thank you for sharing your case and photos.  There are different ways to approach your condition.  Fillers are a less invasive, but temporary solution while surgery will give you a more lasting result.  You may want to schedule a consultation with a surgeon who has experience in both treatments to begin the discussion together.  Good luck!

Samuel Baharestani, MD
Long Island Oculoplastic Surgeon
4.8 out of 5 stars 24 reviews

Tear Trough

You have some prolapsed orbital fat which is why the tear trough area is looking worse than when you were younger.  Fillers are an excellent way to improve this area.  Just make sure you go to someone with experience injecting lower lids, and that they use an appropriate product for lower lids, such as Restylane or Belotero.  Most poor results occur when the wrong fillers are placed here.The other option is to do a lower lid blepharoplasty with fat repositioning.  This will move the fat down into the tear trough to make the lower lid smooth. 

John J. Martin, Jr., MD
Coral Gables Oculoplastic Surgeon
5.0 out of 5 stars 25 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.