I am 30 year-old male with tear trough at lower eyelids, like dark circles. Last year, I developed some small bags that make the dark circles worse. I have no excess skin. I visited some plastic surgeons, and I was offered Restylane injections or arcus marginalis release with fat reposition (not transconjunctival, since bulging fat is very close to tear duct and hard to deal with through that approach).
Is this correct? How close to the bone and inner corner of eyelid can Restylane injections go? My grooves start from the very inner corner next to tear duct.
Answer: Transconjunctival arcus release is best option for tear troughs I have been doing the transconjunctival arcus marginalis release and fat grafting and repositioning for the past 6 years, and transcoinjunctival blepharoplasty with fat removal for 14 years and have never had a problem or injury of the tear duct--it just is not a problem. I also recommend against tear tear trough implants. They can extrude, and placement through transconjunctival incision is difficult. They also can be visible because the skin is thin. Whole autologous fat grafts or fat repositioning is your best choice. From your picture, you are an excellent candidate for this procedure. The transconjunctival approach is much safer for addressing the tear trough because the anatomical approach is much more direct and easy. Working in the area of the arcus and lower orbital rim through an external lower eyelid incision risks the occurance of ectropion and inferior migration of the lower lid margin. I do not do filler injection in the tear trough--visible grey lumps are frequent--the lid skin is so thin the filler can show through. There has been a case of blindness reported in England following filler injection around the eyes. It just is not worth the risk in my opinion. I know many doctors do it, but I have only seen the complications. See before and after pictures of arcus release and fat grafting through transconjunctival approach: Set 1, Set 2, Set 3
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CONTACT NOW Answer: Transconjunctival arcus release is best option for tear troughs I have been doing the transconjunctival arcus marginalis release and fat grafting and repositioning for the past 6 years, and transcoinjunctival blepharoplasty with fat removal for 14 years and have never had a problem or injury of the tear duct--it just is not a problem. I also recommend against tear tear trough implants. They can extrude, and placement through transconjunctival incision is difficult. They also can be visible because the skin is thin. Whole autologous fat grafts or fat repositioning is your best choice. From your picture, you are an excellent candidate for this procedure. The transconjunctival approach is much safer for addressing the tear trough because the anatomical approach is much more direct and easy. Working in the area of the arcus and lower orbital rim through an external lower eyelid incision risks the occurance of ectropion and inferior migration of the lower lid margin. I do not do filler injection in the tear trough--visible grey lumps are frequent--the lid skin is so thin the filler can show through. There has been a case of blindness reported in England following filler injection around the eyes. It just is not worth the risk in my opinion. I know many doctors do it, but I have only seen the complications. See before and after pictures of arcus release and fat grafting through transconjunctival approach: Set 1, Set 2, Set 3
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CONTACT NOW Answer: Tear troughs Yes sounds sensible but be mindful tear trough filler injections along with fillers in the nose has highest rate of complications due to its proximity to the eyes and only to be undertaken by experienced professionals. With that degree of bulging I wonder whether surgery is more of a permanent and effective solution but non surgical methods always have a role to play. Wish you the best in your journey, Dr Leo Kim, Specialist Plastic Surgeon in Sydney
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CONTACT NOW Answer: Tear troughs Yes sounds sensible but be mindful tear trough filler injections along with fillers in the nose has highest rate of complications due to its proximity to the eyes and only to be undertaken by experienced professionals. With that degree of bulging I wonder whether surgery is more of a permanent and effective solution but non surgical methods always have a role to play. Wish you the best in your journey, Dr Leo Kim, Specialist Plastic Surgeon in Sydney
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October 15, 2017
Answer: Tear trough fill Hi and thanks for your great question. I think that surgery can be done but you may have a suboptimal result as you have more hollow than fat (substrate) to reposition and fill the hollow. After surgery don't be surprised if you still need filler as a top off. Filler only avoids the need for surgery and may do the trick for now. Get a good evaluation and don't be pushed into surgery - best...
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Answer: Tear trough fill Hi and thanks for your great question. I think that surgery can be done but you may have a suboptimal result as you have more hollow than fat (substrate) to reposition and fill the hollow. After surgery don't be surprised if you still need filler as a top off. Filler only avoids the need for surgery and may do the trick for now. Get a good evaluation and don't be pushed into surgery - best...
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TREATMENT FOR YOU
December 14, 2016
Answer: Tear Trough / nasojugular ligament There are many causes of eye bags/tear trough deformities. Some are shadow issues, some are discoloration issues. Restylane can go medial but you want some demarcation medially or it will look odd. Below I copied the title of a few good articles you can pull up on google scholar if you are interested. These articles were given to me by a colleague and I use them in treatment protocols. You seem to know a lot about this so I think it will be helpful for you. Even further below are some notes about causes and treatment options. "The Tear Trough Ligament: Anatomical Basis for the Tear Trough Deformity" Chin-Ho Wong, M.R.C.S.(Ed.), F.A.M.S.(Plast. Surg.) Michael K. H. Hsieh, B.Sc. Bryan Mendelson,F.R.C.S.(Ed.), F.R.A.C.S.,F.A.C.S. "What Causes Eyelid Bags? Analysis of 114 Consecutive Patients" Robert Alan Goldberg, M.D., John D. McCann, M.D., Ph.D., Danica Fiaschetti, C.O.A., and Guy J. Ben Simon, M.D. "Dark Circles Etiology and Management Options" Daniel P. Friedmann, MDa,*, Mitchel P. Goldman, MDb,c 1. Prolapsed orbital fat through the orbital septum: treated with lower lid blepharoplasty and fat re-positioning. Can also be helped with fillers or auto fat transfer to the face but the ideal treatment in my hands is surgery for this issue. 2. Ezcema: much more common in young people with fair skin. The treatment for this is to hold off on makeup and any manipulation of the lower lid for a few weeks and try some topical anti inflammatory creams. If you have allergies those should be treated also. A dermatologist is the best person to see for this. We have a multidisciplinary clinic with myself, a plastic surgeon, and my partner, a dermatologist which I think is ideal! 3. Fluid accumulation and/or redundant skin. Could be possible in young patients but would need a good facial analysis and exam to determine. A low salt diet (< 1000mg/day) and a warm compress can help. I would consider treating with filler/fat transfer, lower lid fractional ablative laser and/or lower lid blepharoplasty. 4. Descent of midface cheek pad. This then causes the nasojugular ligament to become more prominent creating a demarcation and separation of the eye from the cheek subunit. Treated with mid face lift and fat transfer. It is all about the balance of this transition from the orbit to the cheek. There are many ways to treat this and they vary by the underlying cause. I recommend seeing a surgeon who also does a lot of these treatments. This can make a big difference as most people have a combination of the above that lead to the issue. Hope this helps. Best of luck, DrC
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CONTACT NOW December 14, 2016
Answer: Tear Trough / nasojugular ligament There are many causes of eye bags/tear trough deformities. Some are shadow issues, some are discoloration issues. Restylane can go medial but you want some demarcation medially or it will look odd. Below I copied the title of a few good articles you can pull up on google scholar if you are interested. These articles were given to me by a colleague and I use them in treatment protocols. You seem to know a lot about this so I think it will be helpful for you. Even further below are some notes about causes and treatment options. "The Tear Trough Ligament: Anatomical Basis for the Tear Trough Deformity" Chin-Ho Wong, M.R.C.S.(Ed.), F.A.M.S.(Plast. Surg.) Michael K. H. Hsieh, B.Sc. Bryan Mendelson,F.R.C.S.(Ed.), F.R.A.C.S.,F.A.C.S. "What Causes Eyelid Bags? Analysis of 114 Consecutive Patients" Robert Alan Goldberg, M.D., John D. McCann, M.D., Ph.D., Danica Fiaschetti, C.O.A., and Guy J. Ben Simon, M.D. "Dark Circles Etiology and Management Options" Daniel P. Friedmann, MDa,*, Mitchel P. Goldman, MDb,c 1. Prolapsed orbital fat through the orbital septum: treated with lower lid blepharoplasty and fat re-positioning. Can also be helped with fillers or auto fat transfer to the face but the ideal treatment in my hands is surgery for this issue. 2. Ezcema: much more common in young people with fair skin. The treatment for this is to hold off on makeup and any manipulation of the lower lid for a few weeks and try some topical anti inflammatory creams. If you have allergies those should be treated also. A dermatologist is the best person to see for this. We have a multidisciplinary clinic with myself, a plastic surgeon, and my partner, a dermatologist which I think is ideal! 3. Fluid accumulation and/or redundant skin. Could be possible in young patients but would need a good facial analysis and exam to determine. A low salt diet (< 1000mg/day) and a warm compress can help. I would consider treating with filler/fat transfer, lower lid fractional ablative laser and/or lower lid blepharoplasty. 4. Descent of midface cheek pad. This then causes the nasojugular ligament to become more prominent creating a demarcation and separation of the eye from the cheek subunit. Treated with mid face lift and fat transfer. It is all about the balance of this transition from the orbit to the cheek. There are many ways to treat this and they vary by the underlying cause. I recommend seeing a surgeon who also does a lot of these treatments. This can make a big difference as most people have a combination of the above that lead to the issue. Hope this helps. Best of luck, DrC
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September 22, 2016
Answer: TheTreatment Of Tear Trough Deformities It's not unusual for patients with tear trough deformities to request plastic surgical consultation. When this situation arises, a variety of treatment options exist to treat this condition. These include surgical procedures that release the arcus marginalis and the use of injectable hyaluronic acid fillers that minimize tear trough deformities. It's extremely important to individualize the treatment of tear troughs. For this reason, the specific procedure chosen will depend upon the patient's anatomic findings and aesthetic goals.It's important to realize that lower eyelid filler injections can be very effective for treating tear trough deformities, but aren't for everyone with this condition. In some patients, the lower eyelid skin is extremely thin and for this reason, injectable fillers aren't always indicated. In this situation, injections may be accompanied by nodules and bluish discoloration.When patients have excess lower eyelid fat, arcus marginalis release and fat repositioning is appropriate. This procedure is associated with excellent clinical results.It's important for patients with tear trough deformities to consult a board certified plastic surgeon with experience in this area. This surgeon should be able to formulate a treatment plan that addresses your anatomic findings and achieves your aesthetic goals.
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CONTACT NOW September 22, 2016
Answer: TheTreatment Of Tear Trough Deformities It's not unusual for patients with tear trough deformities to request plastic surgical consultation. When this situation arises, a variety of treatment options exist to treat this condition. These include surgical procedures that release the arcus marginalis and the use of injectable hyaluronic acid fillers that minimize tear trough deformities. It's extremely important to individualize the treatment of tear troughs. For this reason, the specific procedure chosen will depend upon the patient's anatomic findings and aesthetic goals.It's important to realize that lower eyelid filler injections can be very effective for treating tear trough deformities, but aren't for everyone with this condition. In some patients, the lower eyelid skin is extremely thin and for this reason, injectable fillers aren't always indicated. In this situation, injections may be accompanied by nodules and bluish discoloration.When patients have excess lower eyelid fat, arcus marginalis release and fat repositioning is appropriate. This procedure is associated with excellent clinical results.It's important for patients with tear trough deformities to consult a board certified plastic surgeon with experience in this area. This surgeon should be able to formulate a treatment plan that addresses your anatomic findings and achieves your aesthetic goals.
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June 24, 2016
Answer: Tear Trough Approach Thank you for your question. My patients love Juvederm filler (Restylane, also being a good filler), a lot of them will have filler for hollow eye, this is a great temporary solution. Like yourself, a lot of patients have bulging fat pads, therefore I would advise a transconjunctival blepharoplasty with fat repositioning would be beneficial. Please seek out a board certified plastic surgeon in your area with an expertise in blepharoplasty. All the Best!
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CONTACT NOW June 24, 2016
Answer: Tear Trough Approach Thank you for your question. My patients love Juvederm filler (Restylane, also being a good filler), a lot of them will have filler for hollow eye, this is a great temporary solution. Like yourself, a lot of patients have bulging fat pads, therefore I would advise a transconjunctival blepharoplasty with fat repositioning would be beneficial. Please seek out a board certified plastic surgeon in your area with an expertise in blepharoplasty. All the Best!
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