Deep tear troughs after weight loss. I am a 41 year old female. What are my options? (Photo)

Hi there.  Thank you for submitting your photo and question to the RealSelf physician community. The first question that needs to be answered, in my opinion, is if you feel your weight will be stable at this point in time.  If you plan on losing even more weight it would be advisable to wait until you reach your goal before considering fat transfer.  Once at goal, then your top two options would be artificial filler (ie Belotero) or fat grafting/transfer to the tear troughs.  Even if you lost significant weight, there should be some available fat somewhere on your body to donate since you only typically need a few cc's of fat (ie a teaspoon's worth or so). Fat transfer around the eye must be done with precision and care.  Too much fat with inaccurate placement can lead to poor results.  The surgeon you choose should be asked if he/she is comfortable injecting in this area and if he/she has the proper equipment to do so (ie smaller cannulas...the little "straws" used to inject the fat).  That said, a good fat transfer done well and conservatively should give you many years of result.  Best of luck to you.

It is impossible to give you good advice based on your photo! A variety of options for treatment of this deformity exists. Soft tissue filler like Restylane or fat grafting can create significant improvement. Lower blepharoplasty with transposition of fat pads (if available) is also a solution or combination of these?You will need a detailed evaluation of an experienced board certified plastic, facial or oculoplastic surgeon who can than discuss available options with you. Good luck. 

There are many ways to treat dark circles, as well as under eye wrinkles and bags. It is important to note however, that the majority of times the cause for discoloration is genetic and due to the viability of the blood vessels below the skin. A combination approach is always needed to get the best results in this area and this includes: topical skin care, laser and/or radiofrequency treatments, and fillers if placed appropriately. All my patients are on topical lightening agents, typically a vitamin C serum product in the AM and a brightening agent and/or a vitamin A based product in the PM. Sun protection is essential.Resurfacing and tightening are essential. My patients get offered a menu of options, for which a combination gives the best results. Light salicylic acid peels help give textural and pigment improvement; nonablative lasers (Fraxel or Clear + Brilliant) can be used to tighten and improve fine lines/wrinkles and crepe skin; fractional radiofrequency devices (Sublative, Viva) are cutting edge and improve texture, tone, and wrinkles with very little downtime; radiofrequency with pulsed electromagnetic fields (Venus) are amazing for puffiness and bags, in patients who do not want eyelid surgery; appropriately placed fillers can replace lost volume, cover up the vessels and fat pads below improving the appearance -- patients should pick a well experienced practitioner to prevent complications such as Tyndall (blue discoloration) and irregularities, one that uses a cannula for injection will help give results with little bruising or swelling; microsecond Nd:YAG laser treatments (Laser genesis) has produced dramatic improvement in discoloration in some of my patients and is safe in dark skin types, similar to the radiofrequency devices. For lifting, ablative laser resurfacing such as co2 laser combined with monopoloar radiofrequency deep heating (thermage) give amazing results. The key is for a patient to see a cosmetic dermatologist with experience in all the latest devices and techniques so the persons goals can be met by a combination approach of individualized treatments and skin care. In some cases, those who smile and have crepe skin or under eye wrinkles, a small amount of neurotoxin (botox, dysport, xeomin) strategically placed in the lower eyelid skin can improve wrinkles dramatically and give the eye a more "open" appearance.