Will Tear Trough Injections Work, or Do I Need Something More Dramatic? (photo)

I'm 42-years-old and concealer just isn't doing it anymore. It's rather depressing, as I feel liked I've aged 20 years in the last two. I've been struggling with concealers and home remedies - nothing helps. I'm considering injections after pouring through this website and reading filler reviews. Judging from the photo (turned my head on an angle to get a good shot of the issue), do you think injections will fix my tear trough problem, or will I need something more drastic? Thank you.

Doctor Answers 7

Correction of the tear troughs: filler or surgery?

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Injection of a filler such as Restylane in your tear troughs would be an excellent option. The idea is to add volume to that area of deficiency which has two really nice effects. First, it helps to hide or camouflage your lower eyelid bags by filling below them. Second, it gives you a bit of a cheek-lift by smoothing the transition between the lower eyelids and the cheeks. This is a 5-10 minute procedure in the office with minimal discomfort for patients. A recent study showed that under-eye Restylane injections provide correction as long as 2 years following treatment. The other benefits of using Restylane is that the product is reversible with injection of hyaluronidase in case you desired to do so. When performed by an expert injector, the results should be smooth and natural looking with immediate improvement of your lower eyelids. 

Also, you should seek a consultation with a facial plastic, oculoplastic, or plastic surgeon who performs lower eyelid blepharoplasty as well, as they would be able to best advise you about the surgical and nonsurgical alternatives. In my San Francisco Bay Area eyelid surgery practice, I utilize the fat repositioning technique, in which the lower eyelid fat is not removed but rather moved down into the tear troughs. This provides the cheek lift effect I described earlier and also avoids the "hollowing" which can occur from aggressive fat removal. For many patients, this can be done without any external incisions. If there is loose, sagging skin on the lower eyelid, this skin can be tightened as well. 

Best regards,

Dr, Mehta

Bay Area Facial Plastic Surgeon
4.7 out of 5 stars 52 reviews

Tear Trough and periorbital sunkeness correction

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I think Injectables would replace your lost facial volume. There are many different options, including Juvederm, Restylane, and Sculptra Aesthetic. Of these, I would recommend Sculptra. Drawback is that it requires two session and you have to wait 4-6weeks to see results. Results will be better, more natural, and longer lasting.

Perry Liu, MD
Beverly Hills Plastic Surgeon
4.8 out of 5 stars 5 reviews

Tear Trough Injections are an Excellent Option for the Tear Trough Deformity

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Tear trough injections with hyaluronics such as Restylane would be a good option for you. The intention is to raise up the trough to be at the same level as the surrounding tissue. Think of a valley and two mountain peaks. The valley does not receive the same amount of light as the peaks and consequently looks darker than the surrounding areas (there usually some pigment changes as well that are not addressed by injections).

In your case, you would likely need extended tear trough injections. What I mean by that is that your "trough" extends laterally as well towards the outer corner of your eye. This may mean that you would need more product than is usually used for the standard tear trough deformity.

Whatever you do, go to an experienced, board-certified injector such as the ones listed on realself.

Michael Kim, MD

Michael M. Kim, MD
Portland Facial Plastic Surgeon
4.9 out of 5 stars 41 reviews

Hyaluronic acid is a great option

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As many have already chimed in, injectibles are a nice way to address the tear trough hollows around the eyes. An experienced injector is key, and he/she should understand the injections should be done at a deep level, rather than superficially as is done for wrinkles.


Good luck

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 42 reviews

Tear trough Injections

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You are a good candidate for injectable fillers to your tear toughs and loss of lower eyelid volume. There are numerous filler options and it is a very tricky area to get good results without unevenness and bruising so make sure you have an experienced injector doing it. If your synthetic injectable experience is favorable, you may then consider fat injections to the area which can be more long-lasting and replaces what is really missing.

Dermal fillers under the eyes

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You have what appears to be typical facial fat loss and descent, exposing your lower eye socket bones.  Facial fillers in the tear trough and eyelid/cheek junction would give a good result.  Find a competent injector with lots of experience in this area, as it is one of the more difficult parts of the face. 

Matheson A. Harris, MD
Salt Lake City Oculoplastic Surgeon
5.0 out of 5 stars 6 reviews

A significant issue is the quality of the lower eyelid skin.

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I suspect that you can get good benefit from lower eyelid fillers.  However, yours will be an advanced treatment that requires the hand of a very experienced injector.  Because there is often a need to have the service adjusted, I recommend you try to find an injector close to home.

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