How to restore volume on hollow eye corners (tear trough)? (Photos)

Question

Hello, over the last few years I've noticed a hollowness forming between my eyes and cheek, most pronounced on the outer edges. Please see pic. I'm looking for advice on what treatments can be done, that do not involve repeat injections. I've already tried PRP and skin boosters but these are temporary in effect. What can I do to restore volume to this area in a more permanent way? I'm open to any suggestion, be it topical, non invasive or more invasive methods.

Jag Chana, MD, FRCS(Plast) · Answer

A good option is fillers . PRP and skin boosters do not provide volume. Fillers will need repeating and therefore another option is fat transfer.
Best to get an opinion from a Plastic Surgeon who can discuss the pros and cons of these procedures with you.

Nelson Lee Novick, MD · Answer

I'm not surprised by the lack of success with PRP. I have been cautioning my regular reader for years that the hard science to support this relatively expensive technique lags well behind the social media and marketing hype. Sorry. Asking skin boosters to provide volume would be like asking a hammer to act as a screwdriver. There is nothing wrong with a hammer if its used for knocking in or pulling out a nail, and there is nothing wrong with HA skin boosters if you are trying to increase skin hydration and promote tautness. Sorry again, but no surprise at its lack of success.  The kind of under-eye hollows shown in the photos is fairly common and can be dealt with using an appropriate low viscosity, malleable, cohesive HA filler injected in the proper location with the proper technique. Results with HA fillers in the infraorbital area can last a surprisingly long time, sometimes a couple to several years. You would be wise to consult with a board certified cosmetic dermatologist injector and ask to see his/her before and after photos before agreeing to proceed. Hope this helps and best of luck.

Camille Cash, MD · Answer

The volume loss that concerns you is likely age related.  Other influencing factors can be weight loss and stress.  Fillers can give immediate improvement for this.  The treatment is done in the office with the results lasting about a year.  If you are wanting more permanent results you can consider eyelid surgery.  I encourage you to begin by visiting with a board certified plastic surgeon near you for a consultation.

Mats Hagstrom, MD (license on probation) · Answer

Getting a good assessment and understanding treatment options of the lower eyelid and mid face is fairly complex.
In a youthful face, the contour around the lower eyelid is snug and the area just below, is plump and full of volume.
As we age the two areas create opposing changes. Fullness develops in the lower eyelid as the Peri orbital septum becomes a weak , allowing for protrusion of the lower eyelid fat pads(there are three of them).Just below this volume is lost in the tear trough and mid face.
Since there are two changes, usually happening at the same time, it’s important to first differentiate if bulging of the fat pads in the lower eyelid is primary or a loss of volume just below that. FullNess of the fat pads in the lower eyelids is best treated with a lower eyelid blepharoplasty.
Volume restoration in the mid face can be done using, fillers, and can also be done with fat grafting, a mid facelift or the placement of implants.
Getting the assessment correct and the best treatment is not always easy or straightforward. The key is always finding the right provider.
Different providers will have different views on how to approach this part of facial aging.
in regards to volume restoration fillers are ideal because they are precise, predictable, and forgiving if you don’t like the outcome.
Fat transfer can be permanent, but does not have the advantages fillers do.
Fat transfer is inherently unpredictable, imprecise, and can be unforgiving if patients are not happy with the outcome.
Many people may be apprehensive at the idea of having implants. The mid facelift is fairly invasive, and has a fairly long recovery with swelling and potential bruising.
The two most important variables are understanding your own candidacy, or in other words, understanding the problem and which treatments are likely to work best The second is finding the right plastic surgeon to work with.
To find the right provider, I suggest having multiple in person, consultations with plastic surgeons in your community. During each consultation, ask each provider to open up their portfolio and show you their entire collection of before, and after pictures of the previous patient who had similar facial characteristics to your own. An experienced plastic surgeon should have no difficulty showing you the before and after pictures of at least 50 previous patients. 
Being shown a handful of pre-selected images, representing the best results of a providers career is insufficient to get a clear understanding of what average results look like in the hands of each provider. When reviewing fat grafting results, make sure you understand the timeframe of when after pictures were taken. Early fat grafting results can look very impressive, but do not necessarily represent long-term results. After pictures should be taken a minimum of three months from the date of surgery preferably six months or longer.
Continue having consultations until you feel you’ve met the right provider for your needs.
I suggest avoiding virtual consultations and avoiding traveling, long distances for elective surgical procedures.
Best,
Mats Hagstrom, MD

How to restore volume on hollow eye corners (tear trough)? (Photos)

Answers (4)

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