How can I permanently fix my deep tear troughs and the wrinkles that come with them? (Photo)

Question

I have very thin skin under my eyes that causes significant wrinkles when I smile. I’m only 18 but i feel like my my eyes look closer to 30. It’s a huge issue for my self confidence and I’m looking for a long term solution that l require $800 injections twice or more a year for the rest of my life. I’m willing to try filler initially but I just need to know if there’s a real fix for this or if I’m doomed to have wrinkles and bags forever. Any information is really appreciated.

Hooman Khorasani, MD · Answer

Thank you for the post.  Eye rejuvenation is best addressed with a multimodal approach.  Fractional ablative lasers can be very useful at tightening the skin, removing fine lines and stimulating collagen production.  Combination with microneedling, PRP and fillers can augment and sustain results.  Please see an eye rejuvenation expert for best results and to devise a plan that is best suited for your lifestyle and goals.  I hope this helps!

J. Jason Wendel, MD, FACS · Answer

Thank you for your question about under-eye bags.
There are many non-surgical ways to tackle under-eye puffiness, lines, and/or dark circles.  There are some skin care products you can use.  Some laser treatments such as ErYag lasers can tighten skin under the eyes and help reduce fine lines.  Platelet Rich Plasma (PRP) microneedling can also tighten the skin and help promote collagen production.  Finally, you can camouflage under eye bags by placing fillers such as Juvederm Vollure or Voluma, or Restylane Defyne in the area.   
To be sure, see two or more experienced, licensed and board-certified providers in your area for a complete evaluation to make sure you are a good candidate and that it is safe for you to have treatment. I hope this helps.

Jonathan Kulbersh, MD · Answer

Deep tear troughs and wrinkles can be permanently corrected with surgery or temporarily camouflaged with fillers (Restylane, Belotero, Volbella).There are great non-surgical options to fill in under eye depressions and hollowness. Using dermal fillers, a liquid eye-lift can be performed. A dermal filler such as Restylane would be placed in the cheek and tear trough to hide the depression or bag underneath your eye. 
Surgery would require a fat-repositioning lower lid blepharoplasty. In this surgical procedure, fat from the eye area is moved into the tear trough depression filling the actual depression. 
I hope this helps!

Kenneth D. Steinsapir, MD · Answer

The fillers are actually the state of the art treatment. The duration you quote is in correct. Generally these services persist 10 to 12 month and frequently longer in younger people like yourself. The critical thing is finding the right injector. You asking your face to be sculpted. You are not buying a fungible commodity. Get the right product. That will be Restylane. Avoid runny products like Belotero, Restylane Silk, or Vollubella. These products drift after they have been placed and makes rigides at the top of the cheek. Don’t get grafted fat: you gain weight and the grafted fat gains weight. It’s a big problem.

Jason Emer, MD · Answer

A combination approach will give the most improvement. Fillers, lasers, and microneedling/PRP can improve under the eyes. My patients try to get non surgical treatments to avoid surgery. We use PRP and stem cells there often. I suggest consulting with an expert to develop a treatment plan best suited for your short and long term goals. Best, Dr. Emer

Luis A. Cenedese, MD, FACS · Answer

Lower lid lines are best treated by lower blepharoplasty.  When properly performed bags are decreased, skin is tightened and wrinkles improved.  Scars are difficult to detect; deformities are rare.  Results last for years. Downtime is up to one week. Pain is minor to none.
Non surgical options include CO2 LASER and Phenol Peel. One treatment typically produces results lasting for years. Fraxel LASER, Radio-Frequency treatments and micro-needling with PRP or stem cells are good options.  Several treatments are required lasting up to one year.
Puffy eyelids are most often caused by bulging of the fat which supports the eyelids. Certain anatomies of the lower eyelid region predispose young people to this deformity. Loss of volume of the bony infra-orbital rim accentuates this tear trough in older individuals.
Various options are available. The most successful is injection of filler below the lids and the tear trough.  Hyaluronic acids are most commonly used as they correct the majority of the defect.and last well in this area. The addition of PRP or Stem Cells can help to lighten the skin of the area as well as prolong the duration of correction. Hyaluronic acids can cause a bluish discoloration when injected under the lids. Techniques exist to decrease the probability of this occurring. Over correction with bumps is not rare. These are easily corrected with an injection of Hyaluronidase. Fat injections with their stem cells are more long lasting solutions which in addition correcting the defect help to improve the color and quality of the overlying skin.
Eyelid bags may be successfully diminished by injection of a few solutions. One to a few sessions result in long lasting correction.
Please consult in person with an experienced Board Certified Plastic Surgeon prior to making treatment decisions.

Camille Cash, MD · Answer

Fillers are a good start to help improve under eye irregularities.  The treatment is done in the office and results last up to one year.  I would begin there before considering surgery.  In addition you can keep skin healthy by using medical grade skin care products and wearing sunscreen every day.

John R. Burroughs, MD · Answer

Sorry to hear this is frustrating to you and you are not alone.  Filler provides a fantastic manner to improve deep troughs, but does need repeating.  Typically it will last 1-3 years.  Belotero is my preferrred lower eyelid filler, but Restylane can last longer though carries more risk for a blue appearance.  Fat transfer can be done from your abdomen, behind your knees etc for a more permanent result, but has to be overfilled as it shrinks down some over several months. Fat can last for years (3-5+).  Some patients are starting to see nice results with PRP injection into the lower lids, but this too need repeating.  Quality medical grade skin care is important for patients with thin skin like yours.  SkinCeuticals AOX eye serum, H.A. intensifier, and a triple lipid would be a good place to start.  There are also permanent implants that can be placed, but they have their drawbacks too.  Seek a qualified plastic surgeon/oculofacial plastic surgeon with great reviews, reputation before making any long-term decision.  Best regards.

How can I permanently fix my deep tear troughs and the wrinkles that come with them? (Photo)

Answers (8)

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