Tear Trough Deformity, Restylane Did Not Treat the Problem? (photo)

I have uneven tear trough deformity. I received a restlyane treatment before (2 weeks go to be exact) and obviously that did not treat the problem. Would I be a canidate for surgery that can banish this? The Dr. that did the injections said my under eye circles are a "pigment" problem; is this true? Would be nice to banish the tear trough deformity in total. Any suggestions would be appreciated. Thank you for your time.

Doctor Answers 6

Tear Trugh Treatment with Fat Grafting

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In patients who have developed deep 'tear troughs' at the junction of the lower lid and cheek, adjacent to the side of the nose, the meticulous grafting of fat harvested from the patient's abdomen, hips or thighs can build this area back up and nicely restore a more youthful contour. In some blepharoplasty patients this depression or 'hollow' extends horizontally across the entire junction of the lower lid and cheek, and this must be corrected to obtain the ideal postoperative result.

Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 123 reviews

Surgical correction of lower eyelid bags and dark circles

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If you are seeking improvement and rejuvenation of the lower eyelids then there are two methods, surgical and non-surgical. Non surgical improvement consists of soft tissue fillers such as Juvederm. In addition to soft tissue fillers you may consider microablative fractionated CO2 laser treatment such as SmartSkin and SmartXide will help to tighten the skin. These can be performed in combination.  With the degree of puffiness you have of your lower eyelids I would recommend surgery over non-surgical methods.

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews


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You appear to have thick sebaceous skin transitioning abruptly to think delicate skin at the trough area.  You have a very high risk of an unsatisfactory result with injections, herniated fat relocations, fat transfers, etc.  The  suggestion of injecting Radiesse into this area is not prudent.  This material is white and may show through.  More importantly, it cannot be removed because tissue grows into it.  If you get a bad result, it may embarrass you for many years. Best wishes. Knowledge is power.  Luis F. Villar MD FACS

Luis Villar, MD, FACS
West Palm Beach Plastic Surgeon
4.4 out of 5 stars 11 reviews

Using a combination of treatments for hollowness and pigmentation

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Thank you for your question. The under eye appearance along with a relatively hollow skin between the eyes and having dark circles is not an easy problem to manage. I actually wrote an article years ago called Ethnic Considerations in Eyelid Surgery and recognizing that there different areas to enhance when you feel that your under eye area looks tired and hollow. I think that the Restylane was still a reasonable choice to help improve the hollowness, but to help lighten the pigmentation is a very challenging problem.

People who have come to my practice have often been frustrated with bleaching creams and other treatments, including retinoids due their skin being so irritated they cannot comply with the regimen. What has been successful in my practice is platelet-rich plasma. This procedure involves drawing your blood and spinning it and concentrating the growth and healing factors, then injecting it under your skin.

Now, over the course of several months, your skin quality appears to improve. This is the combination of the collagen build up and improving the blood supply needed for the area. In our own private line of skin care products, we have seen a huge improvement in skin quality with just the use of something topical, which helps rehydrate the upper levels of the skin. By combining these modalities, you will probably see some improvements beyond just the filler.

By adding some volume in the cheek area which is relatively hollow, it will reveal a natural and balanced contour between the eyes and cheek. People tend to look at the whole picture rather than the isolated parts. So if your goal is to look better and not to look so tired, this may be is worth considering.

Instead of immediately opting for only an injectable treatment, I recommend using the combination approach. In addition, these procedures may require more than one visit and needs a longer treatment plan. I hope that was helpful and thank you for your question.

Amiya Prasad, MD
New York Oculoplastic Surgeon
4.4 out of 5 stars 80 reviews

Treating Tear Troughs

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Though I normally don't recommend Radiesse under the eyes, you may benefit from using Radiesse as opposed to Restylane under the eyes, as I have anecdotally found that the white color of the product can lighten the color of the skins appearance as well as fill the tear troughs. 

Cameron Rokhsar, MD, FAAD
New York Dermatologic Surgeon

Tear Trough Deformity Can Be Corrected with Fillers or Surgery

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The deformity in your picture may be corrected with either fillers or surgery.   It appears your previous treatment did not fully fill your trear troughs, and you need more filler.  It can take up to 4ml to correct deep tear troughs.  This can give you an immediate result with rather little downtime or risk, but it must be repeated every 9-12 months. 


Surgery can correct the tear trough.  I would use the lift and fill technique where I move your lower eye fat into a better position, lower transconjuctival blepharoplasty with fat repositioning, and fill you cheek by fat grafting, autologous fat grafting.  Surgery is a permanent option with a week or 2 of downtime. 

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.