Am I a candidate for tear trough implants? Hollow dark circles. (photos)

Question

I have had terrible dark circles my whole life, and now that I'm 30, they look much worse and more hollow than before. I've had consultations for under eye filler, but I've recently learned of severe complications including arterial embolism, persistent inflammation, filler getting trapped in the eye socket where hyaluronidase can't reach, and filler migrating from the original injection site. I really want to avoid these complications, so are tear trough implants a better alternative?

A.J. Amadi, MD · Answer

Based on your photos, which are excellent, you would be a good candidate for an implantech flowers tear trough implant, if you would like to avoid fillers. I am doing more of these surgeries exactly due to reasons you outlined. Unfortunately, there is an "overfill epidemic" that is going on in the aesthetic world with many undertrained or barely trained injectors filling faces...the pendulum will swing the other way soon.

Jonathan Kulbersh, MD · Answer

Thank you for your question and for providing photos. When administered by a skilled injector, tear trough fillers can improve hollowness and discoloration to create a more awake and alert appearance, with results lasting for up to a year or more. 
For a more long-lasting option, a lower blepharoplasty procedure can smooth the transition between the eye and upper cheek by sculpting, repositioning, or removing excess fat. Darkness under the eyes can also be diminished by improving facial tone in this area. Contouring and restructuring the lower lid can make the eyes appear more open, awake, and refreshed. I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon who can discuss any concerns you may have and suggest the best course of action.

Justin K. Williams, MD · Answer

Teartrough deformity is a common complaint by patients. Not only does involve treatment of the tear trough deformity itself, but the cheek fullness which contributes greatly to the appearance of the tear trough. This can be addressed with multiple techniques. Your correct, there are risks involved with injection in the tear trough including embolus of the injected material( whether that be fat or filler). However, injection by a skilled and practiced practitioner can be safe and effective. Other surgical options can include a lower lid blepharoplasty where fat is repositioned in the tear trough is released from the inside of the eyelid. This can improve the contour of the lower eyelid and the transition between the eyelid and the cheek leading to a more youthful appearance. The appearance of dark circles is very difficult to treat but sometimes treatment of the teartrough deformity can improve the appearance of dark circles simply due to changes in shadowing and light reflection. I do not typically perform tear trough implants in my practice.
Eyelid rejuvenation and injectables are common procedures that I perform. Please see the attached link for more information from our practice

Jason Emer, MD · Answer

At home peels like cosmelan, enlighten and aerify along with dermarolling (MTS roller with anteage MD ampules) should be started now. There are many things you can do to treat under eye hollows and dark circles. A surgical option to remove skin and/or fat will such as lower eyelid blepharoplasty with or without fat pad repositioning will be the best long term. There are many things you can do to treat under eye hollows and dark circles without surgery. Non invasive less downtime options such as fillers (Belotero, Juvederm Volbella​), lasers (Moxi/Halo/Fraxel/CO2​), Renuvion (J-Plasma), microneedling/PRP, stem cells and microneedling RF like Fractora PiXel8 or Morpheus can all help give some improvement. Accutite can often be used or stronger lasers like erbium or co2 spot treatment can tighten the skin and give very quick improvement in wrinkles and texture. A surgical option to remove skin and/or fat might be the best solution long-term. I suggest you get a formal consultation to see what is best for you and your goals. Best, Dr. Emer.

Mehryar (Ray) Taban, MD, FACS · Answer

You might be candidate for infraorbital rim implant or perhaps less invasive transconjunctival lower blepharoplasty (with repositioning of eye fat bags). See an expert.

Zoran Potparic, MD · Answer

It appears that major reason for your early development of tear trough deformity is due to small cheek bones. Small cheek implants plus transconjuctival blepharoplasty would be one of the options to consider. When in consult discuss possible eyelid ptosis? Good luck.

Thomas A. Mustoe, MD, FACS · Answer

Tear
Trough implants have their own set of problems in looking natural and the potential problems from the surgical procedure.  Fat grafting is an excellent
long term solution but the results are much more predictable with surgeon experience. Embolization or thrombosis should be negligible with blunt cannulas and appropriate use of local anesthesia which causes vasoconstriction.  There are no large blood vessels in tne tear trough area.  Choose your surgeon carefully. In my experience of more
Than a thousand cases my results have continued to improve even after hundreds of cases.

Robert T. Buchanan, MD (retired) · Answer

Both tear trough implants and properly done filler can correct your problem. Of the two, the implant, in my opinion is far more unpredictable and risky. First, the implant needs to be customized specifically for you and this is difficult even for an expert. Second, your tissues will continue to change over time and the implant will need modification or you will need filler. Although a number of the things you are afraid of with fillers are possible, they are exceedingly rare when the procedure is done by an expert. You need a heavy filler like Juvederm Voluma placed deep on the bone below the orbital ligament. When done properly by an expert, the risks are minimal and the results significant.

Am I a candidate for tear trough implants? Hollow dark circles. (photos)

Answers (8)