Young Male (25) with deformed Tear Trough - Looking for recommendations? (photos)

There are many ways t o treat dark circles, as well as under eye wrinkles and bags. It is important to note however, that the majority of times the cause for discoloration is genetic and due to the viability of the blood vessels below the skin. A combination approach is always needed to get the best results in this area and this includes: topical skin care, laser and/or radiofrequency treatments, and fillers if placed appropriately. All my patients are on topical lightening agents, typically a vitamin C serum product in the AM and a brightening agent and/or a vitamin A based product in the PM. Sun protection is essential.Resurfacing and tightening are essential. My patients get offered a menu of options, for which a combination gives the best results. Light salicylic acid peels help give textural and pigment improvement; nonablative lasers (Fraxel or Clear + Brilliant) can be used to tighten and improve fine lines/wrinkles and crepe skin; fractional radiofrequency devices (Sublative, Viva) are cutting edge and improve texture, tone, and wrinkles with very little downtime; radiofrequency with pulsed electromagnetic fields (Venus) are amazing for puffiness and bags, in patients who do not want eyelid surgery; appropriately placed fillers can replace lost volume, cover up the vessels and fat pads below improving the appearance -- patients should pick a well experienced practitioner to prevent complications such as Tyndall (blue discoloration) and irregularities, one that uses a cannula for injection will help give results with little bruising or swelling; microsecond Nd:YAG laser treatments (Laser genesis) has produced dramatic improvement in discoloration in some of my patients and is safe in dark skin types, similar to the radiofrequency devices. For lifting, ablative laser resurfacing such as co2 laser combined with monopoloar radiofrequency deep heating (thermage) give amazing results. The key is for a patient to see a cosmetic dermatologist with experience in all the latest devices and techniques so the persons goals can be met by a combination approach of individualized treatments and skin care. In some cases, those who smile and have crepe skin or under eye wrinkles, a small amount of neurotoxin (botox, dysport, xeomin) strategically placed in the lower eyelid skin can improve wrinkles dramatically and give the eye a more "open" appearance.

You do have significant tear trough deformity. Your options are 1) filler injection;  2) fat injection;  3) tear trough implant.  Each has pros and cons. See an oculoplastic specialist.

You have a prominent tear trough.  You should consider some HA filler to smooth out the area which will help with the darkness.  If you had the flu, you were most likely dehydrated.  This would cause the fat in the lower lids to shrink, so that the lid looked smoother.  Not long lasting! Change in diet will not significantly affect your look. However, stay away from salted foods as they may make you retain fluid and the fat pads will look bigger.

There are multiple options to address your needs.  Those range from fillers, fat transfer to lower eyelid blepharoplasty.  In a young patient like yourself with deep troughs and lower eyelid bags, a permanent solution such as lower eyelid blepharoplasty may be a better option.  The fat would be moved from the areas of the bag to the hollows and troughs.  We often perform this procedure without any visible incisions (from the back of the eyes). With your skin color, you would be an excellent candidate to tighten the skin with Active FX CO2.  Please read our article about this procedure.   Best of luck. Dr. Michael Omidi









An in-person exam with a
board-certified plastic surgeon is the best way to assess your needs and
provide true medical advice.

There are many different opinions about how to deal with tear trough deformity. I urge you to look at photographs for evidence of efficacy. Fat grafting, when expertly performed can provide permanent, natural looking smoothness to the lower lids and in fact, most areas of the face that could benefit from additional fullness. If an inexperienced physician overfills the area with fat the result will be lumpy, unnatural and sometimes just odd looking. I have seen many people make the mistake of removing fat under the eye in hopes of smoothing the under eye area. The results of this procedure can be disastrous and disfiguring. You can learn a lot from the photos, videos and answers posted on Realself. Take your time when selecting a plastic surgeon to make a permanent change to your under eye area. You want the results to be natural looking and permanent.

When you have a tear trough deformity you have a deficiency of tissue along the inner border of the lower eyelid.  There are many ways to correct this.  The easiest nonsurgical way is to put filler along the rim of the orbit.  This must be done with caution as someone who is not skilled in injecting may potentially inject the Angular artery there and that can lead to blindness.  However with filler this needs to be done every year to two. There are surgical ways to correct this as well.  Harvesting fat and fat grafting this area has improved the deformity considerably.  The only issue with fat grafting this area is how the fat grafting is done.  This varies considerably from surgeon to surgeon.  The technique of fat harvesting, preparation and injection all play a major role in how the results look.  Plus fat survival is not 100%.  There are other methods of blepharoplasty where fat is relocated or transposed to that area that can help.  Back in the old days Dr. Flower's actually made an implant to be placed along the lower orbital rim to hide this deformity.  This is known as a tear trough implant made by Implantech.   You have to decide if you want nonsurgical vs. surgical correction.