Tear-trough correction 25F, what options do I have (surgery is last resort)? (Photo)

Question

Hello, I wonder what options I have to make my tear troughs less prominent, with surgery being my last resort. Filler is the standard option, but I've seen so much pushback against tear-trough filler which is devastating because it was my easy fix, but now, I am very reluctant. I've heard "threads" are an option as well. It would be nice to get an eye lift that also gets rid of these troughs. Any suggestions are greatly appreciated!

Lori Warren, MD · Answer

Hi! YES, you still have a lot of great options! As an aesthetic APRN injector I do not use HA for tear troughs because I think it can look heavy and can pull water to the filler making it look more puffy at times. My go to under eye treatment for dark circles, volume depletion and improved texture is PRP injections and smooth threads. The two treatments used in conjunction with each other really improve the eye tissue beautifully by stimulating your own natural collagen to improve the look of the tissue around your eyes, with no risk of heaviness. Some patients do experience bruising depending on if they bruise easily or not but the results are worth it in the end. I hope this helps!

Nima Shemirani, MD · Answer

Hi @SolAqua! The upper cheek is a major support for the under eyes. I would first begin with addressing the volume loss in the cheeks followed by addressing the tear trough area. I recommend seeking treatments from expert injectors who have the skill and experience to precisely inject fillers into treatment areas and avoid risks and complications.

Harold J. Kaplan, MD · Answer

Hello SA.  You are a very good candidate for fillers.  If a practitioner says you are not, then there is something else going on.  Either that practitioner is not comfortable doing the work (see photos at link below), or perhaps they are suggesting surgery instead.  Either way, you are young and should probably look at alternatives to surgery at this point.  Restylane is the go to product under the eyes and 1-2 syringes would be appropriate for you.  Best of luck.

A.J. Amadi, MD · Answer

Tear trough implants are the most predictable, reliable and long lasting procedure when it comes to volumization of the tear troughs without the problems of swelling and edema that one can see with fillers, or the lumpy/bumpiness that can occur with fat transfer.
Virtual consultations are available with before and after photos.

Nelson Lee Novick, MD · Answer

The upper cheek region is a major structural support for the tear trough area. Loss of volume there can lead to the development of tear troughs, hollows and bags. So, very often, the use of an appropriately robust HA filler injected into the upper cheek region can not only refine the contour of the upper cheek, but create a smooth transition between the upper cheek and under-eye area WITHOUT THE NEED TO DIRECTLY INJECT THE TEAR TROUGHS. You would be wise to make certain to consult an experienced, board certified cosmetic dermatology injector.. Hope this helps.

Zoran Potparic, MD · Answer

Very difficult to give you good advise based on this poor photo. Most likely that transconjuctival lower blepharoplasty would be the best way to correct TT deformity. In person consultation with  board certified plastic or oculoplastic surgeon is recommended. Good luck.

Darryl J. Blinski, MD · Answer

Nice 1 posted photo. The #1 treatment to the tear troughs are low prime HA fillers like VoBella or Restylane . The next option is nano fat grafting. Threading is a fool's option. Best to seek either in person or virtual consultations.