What is the Best Procedure is to Correct the Troughs Under my Eyes?

I have deep indents from the corner of the inside of my eyes that goes down my cheeks, fairly deep. it really bothers me, and i need to do something about it. i tryed restylane but it did nothing, although i only had about $600 total injected in both sides. I was thinking maybe lower Blepharoplasty? please help.

Doctor Answers 11

Treatment for sunken contour underneath the eyes.

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Sunken contour underneath the eyes is a common problem with standard aging of the eyes and face.  There is the bagginess of the eyelids that accentuate the depression along the orbital rim just underneath the eyes.  Additionally, there is a "tear trough" deformity that goes horizontally from the tear ducts along the side of the nose.  I don't feel that there is a single best answer for treatment of these areas, however generally speaking lower lid blepharoplasty helps with baggy contour.  This can be combines with fillers such as Restylane or Juvederm to fill in the residual contour problems, even along the tear trough deformity.  Care must be taken when performing injectable fillers because in this delicate area bruising can occur.  Also sometimes lumpiness and bumpiness can be softened up with gentle pressure in the area.  A more comprehensive treatment is fat injections to the tear trough as well as the lower eyelid region.  This, once performed with an expert who has done a lot of these treatments, can achieve excellent rejuvenation to the tear trough, as well as to the contour indentations along the lower eyelid areas.  Fat injections are permanent but also require formal procedure whereby fat is taken from the abdomen and gently placed into the contour abnormalities to the lower eyelids.

Bellevue Facial Plastic Surgeon
4.3 out of 5 stars 23 reviews

Treatment for tear troughs

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

We do not recommend fillers in that area due to the complications we have seen with fillers injected into that area. The tear troughs can be filled with repositioned fat or just a simple removal of the fat through a standard transconjunctival blepharoplasty. 

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 157 reviews

Tear trough problem

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Difficult to tell you what would work without an exam. The photos is hard to see.  Usually for minor depressions, fillers can work well. You may need more.  A blepharoplasty does not tackle tear troughs too well.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

What is the best way to correct "tear trough" deformity of lower eyelids?.

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

It's difficult to see the extent of the deformity of the lower eyelids in your case from the photo that you sent. I would need to see a closeup frontal and side view. Fillers such as Restylane and Juvederm offer a temporary fix usually lasting 6-8 months. I have used 0.5cc of Sculptra injected from a distance under the orbicularis muscle with success with correction lasting 2 years or more. Sculptra has to be used very carefully to avoid detectable lumpiness.

I have also used micro-fat grafting via a blunt 18 or 19 guage needle in the sub-muscular plane into the tear trough. This works nicely if there isn't any excessive bulging of peri-orbital fat.

Lower eyelid surgery known as a  Blepharoplasty may be necessary in order to remove excess fat from the lower eyelid compartment. This procedure can be performed as a transconjunctival ( from the inside of the eyelid) procedure or through an external incision right under the eyelash line. In this way the excess fat can be removed, cut into small pieces and this fat can then be surgically inserted as a graft in the tear trough area via the lower eyelid incision. This technique works very well and is permanent.

Joel B. Singer, MD
New York Plastic Surgeon

Best Way to correct Tear Trough Indentation Under the Eyes

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

The Tear Trough (Nasojugal) indentation which appears between the lower lid and the cheek is the result of attenuation of soft tissue coverage over the lower rim of the eye socket. It first appears along the inner aspect of the lower lid/cheek junction and gradually extends sideways as a result of gradual sagging of the cheek mass which uncovers and unveils the underlying orbital rim.

Any soft material which adequately covers the orbit ledge would soften this look. Unfortunately, the choice of materials is very limited by the extreme thinness of the overlying skin which would render many otherwise suitable materials inadequate in THIS location.

Restylane, placed deeply, is a great material. But to get the effect you want you need to have adequate amounts of it placed. I suspect you had 1cc placed when you would probably have benefited from 3-4cc.

If this bothers you, I would recommend you see a Plastic surgeon and have this treated completely.

Peter A. Aldea, MD
Memphis Plastic Surgeon

Permanent fillers can have permanent problems. The face continues to age, permanent fillers do not.

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Clearly there are many potential options. I prefer the use of long term fillers rather than permanent fillers, particularly in the sensitive tear trough area.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Options for trough under eyes

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

The eyes are the windows to the soul. All too often, however, they seem to reveal exhaustion. The very delicate skin around the eyes tends to get crepey and puffy due to fatigue and stress. Eyelid surgery has become one of my most popular procedures. If excess upper eyelid skin is hooding the eye and needs to be eliminated, an incision is made in the crease at the top of the lid and excess fat and skin are removed. The incisions are closed and sutured on the underside of the skin. If undereye puffiness and dark circles need to be eliminated, an incision is made along the lower lashes that will be almost invisable when it heals. Next, the fat below is either removed or redistributed and the saggy and crepey excess skin is then pulled up and cut off. The incisions is closed with tiny sutures, which are removed in four to six days.

An effective non-surgical option that might benefit you is Thermage, which can tighten the skin around the eyes. The new and improved Thermage is a virtually painless, non-invasive (no incision!) treatment that can tighten skin and stimulate your body to make healthier collagen—the building block that provides structure to your skin. Fast and easy, Thermage requires no downtime from normal activities.

Injected fillers can be used to improve the appearance of the skin's texture and contour. Typically made from hyaluronic acid or fat, injectable fillers can help fill out deep facial wrinkles, creases, and furrows, providing a smoother, more youthful-looking appearance.

Michelle Copeland, MD, DMD
New York Plastic Surgeon
4.6 out of 5 stars 10 reviews

Restylane is still your best option

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Just because one doc could not get the job done, this does not mean you should abandon under eye Restylane. For someone your age and with your issues, hands down, under eye treatment with Restylane is much better than surgery.  Unfortunately treatment remains an art form.  The product needs to be sculpted into your lower eyelids. This means not every Tom, Dick, or Jane will be able to do this service.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Fat transfer for under eye hollows

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

I would agree that temporary fillers such as Restylane should be able to give you a nice improvement. Remember that these fillers are volume-responsive, so if one tries to stretch too little over a larger area of volume, you won't see as much improvement. Sometimes, you may need a little more depending on the anatomy.

If you are interested in a more permanent solution, transfer of your own fat to the under eye area can give a tremendous improvement. In experienced hands, about half of the fat will survive and provide some permanent resolution of the deep hollows.

Good luck.

Jason Litner, MD
Beverly Hills Facial Plastic Surgeon
4.5 out of 5 stars 52 reviews

A well-performed Injectable Filler treatment may improve the troughs under your eyes.

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

I read your concern and reviewed your photo. You appear to have typical lower eyelid grooves that respond well to Injectable Filler treatments. I'm not sure why you had no response with a prevoius treatment. The lower eyelid area is very delicate, and sometimes several treatments are necessary for complete correction. My personal preference for lower eyelid grooves is Silikon-1000 for permanent results.

If any of my colleagues wish to learn more about my experience with Silikon-1000, I am giving an instructional course in Boston at the upcoming Fall Meeting of The American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS). The course is titled "Off-Label Applications of Liquid Injectable Silicone (LIS)", and I will be presenting on 9/24/2010 at 4pm. Common conditions treated include: volume replacement, wrinkle reduction, lip enhancement, acne scarring, and correction of many nasal irregularities (“Non-Surgical Rhinoplasty”). I will also be describing the serial puncture, microdroplet technique that is essential for achieving desired results.

I hope this is helpful for you.

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 435 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.