19 year old female - Best option for hollow under eye tear troughs? (photos)

Hi, I am a nineteen year old female and have pretty severe tear trough hollows. I've been masking this pretty much my entire life and I'm sick of having to wear makeup every day to cover it (which doesn't really help). I would like to explore an option to permanently fix them, preferably something that would be a be-all-end-all solution. I'm sick of people telling me I look tired every day, regardless of how much I've slept. I've attached pictures, any suggestions would be great. Thanks.

Doctor Answers 11

Easiest option is fillers, but there are other options in smooth the tear trough shadow.

Hi Maple96,

A lower eyelid surgery will not help with tear troughs. To remove more fat under the eye, will only make the area look darker. It is already hollow and concave. To reduce shadowing of a concave area, it needs to either be flat or convex.

Your options are either fat grafting, fillers or a tear trough implant. For patients under 40, I tend to recommend fillers over fat grafting. Fillers are bio-inert, meaning it is not alive and will not grow with weight gain or shrink with weight loss. For patients under 40 who are women, there is the possibility that they may become pregnant, and the fat grafted area can actually grow in volume out of sync with the rest of the face with the pregnancy or weight gain. For this reason, I prefer fillers in particular Restylane. The main draw back with fillers is that it requires repeated treatments to maintain the result, typically in the 12-24 month range. The filler naturally dissipates at a very slow rate, not dissimilar to the rate of volume loss with natural aging. The other benefit is that if for any reason the filler does not look good, it can be dissolved with an antidote called vitrase. The other recent topic of interest with injectable fillers is potential infection with the filler which is treatable with antibiotics, but once the filler is contaminated with bacteria, it should be dissolved away completely and start over or switch to fat grafting as an alternative.

The benefit of fat grafting is that the fat is alive and has a blood supply. If there is an infection of the fat grafted area (like a pimple) any antibiotics that you take will be able to be delivered into the fat because of the blood supply. The filler does not have a blood supply so infections are more of an issue. Interestingly, most temporary fillers have not had an infection issue in the smile lines and lips (which is less clean than other area) probably because it tends to dissolve much faster in either 4-6 months for Restylane or 9-12 months for Juvederm. In those areas, it probably dissolves before there is a chance for infection.

Interestingly, Restylane which only lasts 4-6 months in those areas is lasting much longer in the lower eyelid tear trough area. If it is lasting 12-24 months or longer, we should be thinking of it as an implant, such as a silicone chin implant, or a silicone tear trough implant, or cheek implant. Pacemakers and joint replacements are also implants. If these implants get an infection which does not clear with oral antibiotics or IV antibiotics, most likely the implant has developed a biofilm or a film of bacteria which cannot be "cleaned off" of the implant. These implants would need to be surgically removed and replaced either at a separate surgery or at the same time depending on the surgeon or extend of the infection.

For the injectable fillers, the way to remove this type of "implant" it is to dissolve it instead of surgically removing it. Depending on how it was injected it most likely will take more than one session to completely dissolve the filler. The chance of this happening is much lower than 1%. There has been more discussion of this rare problem in national conferences for dermatology and cosmetic surgery.

I use Dermasculpt microcannulas when performing these injections to reduce the chance for bruising.  To see examples of what fillers such as Restylane can achieve for the lower eyelid hollowing such as tear troughs or even bona fide eyebags, please click on the web reference link to see some examples.


Dr. Yang

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New York Facial Plastic Surgeon
4.8 out of 5 stars 30 reviews

Fillers & Volumizers Are Especially Helpful For Treating Hollows Under The Eyes & Tear Troughs In Younger People

Loss of volume in the region of lower lid-cheek junction is largely responsible for the hollowness and tear trough formation that comes with the passage of time. Genetic factors and sun damage play a role in determining how early these problems are seen and how extensive they are. 

The photos provided suggest that it would be wise to build up the "platform" below the tear troughs (rather than first treating the tear troughs themselves). Often this approach alone significantly secondarily improves the tear trough region immediately above. I typically use Juvederm Ultra Plus XC for this purpose in my Upper East Side Manhattan office and Stylage XXL in my Israel satellite office (where a greater number of injectable fillers and volumizers are regulatory agency approved).

If the tear troughs themselves still require treatment I would opt for Belotero Balance, a filler with little chance of causing the unwanted bluish Tyndall Effect when injected superficially into delicate tissues such as in the under the eye area. Both treatments can be completed within the same treatment session, if desired, and only take a few minutes each to perform.

It is crucial to see consultation and treatment by a board certified core aesthetic physician with extensive experience and expertise in treating the periorbital region.

Nelson Lee Novick, MD
New York Dermatologic Surgeon
4.8 out of 5 stars 22 reviews

Tear Trough Hollows

Either Restylane or Boletero would be a good choice for correcting the tear trough area.  There may be some mild bruising after the injection and I would recommend you take Arnica before the procedure.  For the best results please contact a board certified dermatologist with experience in tear trough injections.

Tear troughs

Hyaluronic acid fillers (HAs) are commonly used to improve the appearance of tear troughs. While not a 'permanent' solution, it will provide upwards of a year (in most cases) of correction. Fat could be used as well, however I would recommend HAs first to see how you like the change as they are readily available and reversible 

Janet Turkle, MD
Indianapolis Plastic Surgeon
4.8 out of 5 stars 50 reviews

19 year old female - Best option for hollow under eye tear troughs?

In my opinion I prefer Belotero-Balance HA filler ( Rare Tyndall effect) + microBotox. Fee $1,250 per session.. 

Tear trough injection with Resylane or Belotero

Thank you for your question and posting appropriate pix. You are a great candidate for Belotero or Restylane (lasts longer) in this area. Eventually fat grafting or LaViv is an option.  please make sure to seek consultation with a board-certified expert injector as this is an advanced injection area especially for fat grafting.

Kevin Tehrani, MD, FACS
New York Plastic Surgeon
4.9 out of 5 stars 84 reviews

Deep tear troughs

You do have some deep tear troughs.  I would try some HA filler first, and would recommend restylane or belotero.  Juvederm is not the best option here as it can swell quite a bit.  If you like the way you look with the HA filler, you could then consider putting fat in which would provide a longer term correction.  Tear trough filler is not easy to do, so make sure you go to someone skilled in injecting into this area.     

John J. Martin, Jr., MD
Coral Gables Oculoplastic Surgeon
5.0 out of 5 stars 24 reviews

Tear troughs

Some people have naturally prominent tear troughs.  Filler products like restylane are good products for this region.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Under eye hollows

I would suggest you try a temporary filler first, before you opt for something more permanent. I typically use Belotero in this area, which works very nicely. A consultation with a plastic/facial plastic surgeon/dermatologist who is comfortable with fillers in this area would be a great idea to explain all your options, especially the more permanent ones. 

Dilip D. Madnani, MD, FACS
New York Facial Plastic Surgeon
4.8 out of 5 stars 73 reviews

Tear trough

We treat this area with fillers and sometimes even some fat grafting    Both of these techniques fill the hills area quite nicely. Good luck

Sanjay Lalla, MD, FACS
West Orange Plastic Surgeon
4.9 out of 5 stars 43 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.