Tear trough/cheek area- Options? (photo)

Hello all-- i'm 45 years old and I would like to restore my tear trough/cheek area. I'm an avid athlete and I've noticed over the years that there is now a deficiency and would like a refreshed look. I'm never tired but i'm afraid my face looks it. would you recommend Restalyn or Juvederm? Just not really sure which option would be best and get the most longevity from it... Any referrals to a physician in the Boston area would be welcomed!--keep in mind the photo is from a camera phone.

Doctor Answers 5

Tear trough

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Boston Cosmetic Surgeon
Dr. Daniel Del Vecchio


Baltimore Plastic Surgeon

Volume Loss in Tear Trough/Cheek Area

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Most athletic individuals notice that they tend to lose volume in the face quickly so an overall facial volumizer is a good option. Sculptra is a great option and lasts for 1-2 years. An excellent Boston physician is Dr. Jeff Dover.

Kimberly Butterwick, MD
San Diego Dermatologic Surgeon
4.9 out of 5 stars 20 reviews

Tear troughs

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I would have to see you in person to tell for sure, but it looks like you have what is known as pseudofat herniation of the lower eyelids combined with the normal decent of the midface fat at your age. This along with having a thin face and loss of midface volume is what makes for deep tear troughs. If a tear trough is very surperficial and there is really no significant pseudofat herniation, the off label use of hyaluronic acid filers can be a possibility. I tend to use Belotero Balance. Some surgeons use Restylane or Juvederm. However, in most men with pseudofat herniation, the real standard of care is a lower eyelid blepharoplasty with fat transposition. This is done through an incision on the inside of the eyelid or externally. I prefer the inside incision, transconjunctival. You really cannot build up a depression to match the height of an abnormal protrusion of fat. You are going from a deep valley to the top of the hill. Also, the injection of the tear troughs is more risky than the surgery. It is not just a simple depression. The attachments of the muscles in this area are pretty complicated. I think the surgery, which also is usually one time thing, is safer. I have attached a link for you. Happy to see you in Stoneham or Worcester.

Volumizers & Fillers Work Well To Restore Augment & Recontour the Cheeks & Tear Troughss

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There is no question that when the undereye area doesn't look great, we don't look good overall. As you plainly are experiencing, we can appear tired or exhausted worn out, frazzled, and older when in fact we feel absolutely fine. With the passage of time, many of the changes that we see result from shrinkage shriveling, and a downward descent of a once robust, heart-shaped fat pad that sat immediately under the lower lids and extended out toward the temples, inward toward the root of the nose, and downward about half-way to the angles of the mouth. The loss of this volume and its displacement in the direction of the jaw elongates the lower lid to several times its narrow youthful width and leaves it somewhat sunken.

Likewise, the thin, delicate skin below the eye darkens in part due to the reflection of the darkish color of the underlying vessels that were once hidden by the presence of the fat pad. And, finally, like a balloon having lost its air after being fully inflated for a long while, the skin of the lower eyelid fails to snap back to its youthful smoothness, and instead remains crinkled and baggy.

In the past, lower lid blepharoplasty was the only treatment for these problems. Today, many wishing to avoid the expense, discomfort and downtime can be treated with the injection of volumizing and filling agents to restore the volume to the lower lid regions and to treat hollows, dark circles, and tear troughs and recontour them and diminish the darkish discoloration.

A variety of volumizing agents have been used for this purpose. They include Radiesse, Perlane and Juvederm Ultraplus. My personal favorites are Juvederm Ultraplus for providing overall smoothness and shape and Perlane when more of a lift is required. When necessary, I combine both agents to recontour and lift the cheek directly below lids to support them.

For the very thin skin immediately below the lashes of the lower lid, to treat hollows, tear troughs, and dark circles, I prefer to combine a tiny amount of Radiesse (which has a whitish color for masking) and Belotero Balance. Since the bulk of the materials used are composed of hyaluronic acid, should the need arise, they can be dissolved quickly with microdroplets of an enzyme known as hyaluronidase.

It usually takes about five minutes to treat each lower lid, and the results are immediate, typically evoking a "Wow!" response from the patients when they look in the mirror.

While minimal bruising, tenderness, swelling and redness may occur following treatment in this delicate region, these are usually temporary and disappear spontaneously within one to seven days. Most people can return to work or social activities immediately or the following day and may use makeup if desired.

An in-the-flesh consultation with a board certified aesthetic physician with extensive experience witth these techniques is strongly urged.

Fat Grafting for tear trough area

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Many athletes do have very thin faces and some do wish to make a change. I often perform fat grafting to the tear trough area with beautiful results. Fat can be the most natural looking and feeling filler when performed by a plastic surgeon experience and expertise with structural fat grafting.
There are a wide range of techniques, instrumentation and experience among the surgeons that perform fat grafting. Because of the tremendous variability in all of these factors, there is tremendous variability in fat grafting results. The unfortunate reality is that not everyone who performs fat grafting is willing to put in the level of education, training, investment in instrumentation and operative effort required to produce aesthetically ideal results.
A natural-looking result is of particular importance to most men, who cannot "hide" behind hair and makeup. Look at a lot of before and after photos, do a lot of research, and ask medical professionals who they trust as a plastic surgeon

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 123 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.