Tear Trough Injections

I have always had dark circles that seem bone structure related. Only the left side is visible in the photo, but both sides are the same. I feel this gives my face a very weathered look though I am only 21. Would I be a good candidate for fillers? If so, what kind, and what would be a cost estimate for a good surgeon in a metropolitan area? Also, my mother had "bags" removed in her 30s. If I have a hereditary predisposition to that, are there risks associated with fillers? Thank you.

Doctor Answers 10

Fillers for hollows under eyes

Dark circles under the eyes can be due to skin discoloration, the shadow caused by protruding lower eyelid fat and/or your bony orbital structure. When its a bony structural issue, there are several options including tear trough implants, fat grafting and injectable fillers. In my practice, I have had good success with the use of restylane to improve tear trough hollows and resulting discoloration. But a word of caution - you should use an experienced surgeon for this advanced injection technique. An alternate in some cases is the use of sculptra. However, sculptra should not be used in the tear trough but rather it should be injected into the upper cheek to lessen the gap between the lower eyelid rim and the bottom of the hollow.

Palm Beach Facial Plastic Surgeon
5.0 out of 5 stars 2 reviews

Non surgical treatment for dark circles or tear trough

Lily- I agree that it appears that in this photo you appear to have some hollowing under the eyes in the area of the tear trough and as you mention this may be structural. There are some cases which are hereditary and given your Mother's history you may have a predisposition to early signs of aging under the eyes. I would also recommend you rule out allergy as a possible cause of darkness under the eyes.  As others here have mentioned, fillers such as Juvederm or Restylane are both good options. There are risks with any filler or injection. Be sure to see a physician trained in filler use around the eye. Best wishes


Travis L. Shaw, MD
Richmond Facial Plastic Surgeon
4.8 out of 5 stars 22 reviews

Under eye Restylane is an excellent treatment choice.

Dear Lily

It is important to see a very experienced injector.  This is an art form.  If treatment is not correctly done, you have a risk of lumps and bumps. These can be adjusted after treatment.  Do not let anyone perform surgery on your lower eyelids.  They might mean well but the will not be helping you.  I suspect for many years, you can simply get lower eyelid fillers and be very happy with this type of service.  Longevity of the treatment is well over a year.  Because this service is off label, discuss with your cosmetic surgeon if treatment is right for you and what can be expected compared to alternative forms of treatment.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Fillers can help tear trough accentuation

I often tell patients there is no definite age for considering a cosmetic intervention.  We are all "built" a bit differently--in your case it seems that you have inherited a tendency for a tear trough deformity--a lack of soft tissue support in the under eye area that accentuates blood vessels in the area, resultant brown pigmentation, and can give individuals a "tired" appearance. A small amount of a hyaluronic acid filler, such as Restylane or Perlane, can provide "cushion" between the skin of the under eye area and the bone, decreasing the appearance of the tear trough deformity.  Ask a physician about topical numbing cream and the use of a filler that is premixed with an anesthetic, the procedure should be nearly painless.

Melanie D. Palm, MD
San Diego Dermatologic Surgeon
4.9 out of 5 stars 23 reviews

Tear trough injection

Injections to the tear trough area are for volumizing the area. and improve on the demarcation line between the eye and the cheek. However they are not design to get rid of the dark circles, they actually may make them worse because of how light is reflected through them once they have been placed underneath the skin.


Dr SIegel

Michel Siegel, MD
Houston Facial Plastic Surgeon
4.6 out of 5 stars 112 reviews

Tear trough (under eye hollow areas) can be treated with fillers

Restylane/Juvederm can be used to diminish the appearance of under eye hollows regardless of a patient's age.

The area must be treated very carefully and the filler must be injected quite deep so that you will not see any visible bumps or irregularities underneath the very thin eyelid skin.

Fillers like these are temporary and can last anywhere from 6-12 months.

You may also consider a fat transfer to this area for a more long lasting effect.

Best wishes,


William Bruno, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 377 reviews

Tear trough injections for under eye hollowing

Age is only a number, and that  be applied in both directions.  Under eye hollowing can also be a familial / natural trait.  In such cases, a "young" patient may needlessly look tired and older beacuse of it. Careful application of under eye injections with dermal fillers (my preference is Restylane) can significantly reduce that tired / hollow look.  I can give you some good referrals in Chicago should you want to proceed with injections.  All the best, Dr. Vartanian.

A. John Vartanian, MD
Glendale Facial Plastic Surgeon
5.0 out of 5 stars 16 reviews

Tear Trough fillers

A prominent tear trough can accentuate dark circles; however, they do not cause them. Dark circles can be caused by visible blood vessels in protruding fat, hyperpigmentation of the skin itself or prominent blood vessels in the skin or a combination thereof. I think restylane is the best filler in the tear trough due to its thicker nature and less visibility in the skin overlying it. You have to be careful to make sure that the dark circles are not made worse by overfilling the area. I hope this information helps.

Scott Trimas, MD
Jacksonville Facial Plastic Surgeon
5.0 out of 5 stars 20 reviews

Injectables are great treatments for tear trough problems around the eye.

You indeed have a depression that creates a shadow on the bottom lid near the nose.  Injectables, like Juvederm, work will to camouflage this issue.  If you ever need to have the lower lids, fat can be transferred to the depression to permanently fix the probem.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.7 out of 5 stars 35 reviews

Tear trough fillers

I my experience, these fillers work best in the younger patients if they have a true tear trough.  Restylane is best imo as Juvederm seems to cause prolonged swelling. Avoid other fillers, especially "permanent" ones.  Also, insist on a doctor doing the injections as there are risks injecting near the eye and a non plastic surgeon or a non-physician is less safe here, again my opinion.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 67 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.