Very deep tear troughs, do not want filler. Surgical or non surgical route? (Photos)

Hi, thanks for your question! In general, options for tear trough management include 1) Dermal fillers such at Restylane 2) Fat grafting (usually taken from the abdomen, thigh, or gluteal region) and 3) Lower blepharoplasty with fat repositioning. Surgical treatments tend to be more durable, but some patients find it helpful to trial filler (which is shorter lasting) before comitting to a procedure. As always, I recommend consulting in person with your physician before making any treatment decisions. Hope this is helpful!

I don't see any eye bags in the photos, but I do see the deep tear troughs. Without using fillers ( HA or biostimulatory), I would recommend autologous fat injection or fat transfer from the lower eyelid. In your case, there is no need to remove any bulging fat. Both procedures would provide an improved contour to this area. The fat is usually taken from the abdomen or inner thigh to be transplanted to the eyelid and cheek junction.

In cases like yours, deep tear through deformity can be treated with transconjuctival lower blepharoplasty. This will improve TT without need for skin removal. In person consultation with a board certified plastic surgeon familiar with this procedure is recommended. Good luck.

Since you haven't done anything yet to this region, I would recommend that you start slowly.
PRP/PRF/PRF gel are all great options for the undereyes. The risks of doing these are very low, the results are nice but not overdone, in the right hands, and can also help in collagen regeneration.

Fillers, which you noted you want to avoid, can be done, but a very smooth and thin one must be used for this delicate area. Despite the expectation that fillers (HA) will dissolve, they don't always, so that must be considered when using these anywhere but especially the unforgiving undereye region.

Fat can be a nice option but since you haven't done anything yet, I wouldn't recommend jumping into this potentially permanent option.

Sculptra is not intended to be used in this area though some providers use a more dilute solution for this off-label indication. I wouldn't jump into this option yet either.

Anatomically, the eyes appear to be significantly recessed backward. The eyebrows are protruding, while the eyes themselves are sunken inward.As a result, there is a lack of volume under the eyes, and the tear trough is deeply pronounced.There is a severe tear trough hollowing accompanied by protruding fat, creating a noticeable step-off that casts shadows, making the area appear more severe and tired.A surgical option to consider is lower eyelid fat repositioning. This procedure approaches through the conjunctiva to release adhesions around the tear trough and repositions the fat to fill the hollowed areas.Based on the photos, there seems to be limited fat under the eyes, so additional fat grafting may be necessary.