Tear Troughs/ Under Eye Hollowness, What Is The Most Affordable, Safe, Long Lasting & Best Option For This Matter?

Hello all , So fact of the matter is, I was born with tear troughs & I hate them more then anything, Ive tried all kinds of makeup tricks some look ok & some made it worse. What is the most affordable,safe,long lasting & best option for this matter?

Doctor Answers 10

Hollow Eyes and Tear Troughs Best Treated with Blepharoplasty and Fat Grafting

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Thank you for your question.Restylane and fillers will not give you a permanent result and personally I am uncomfortable with repeated injections through the delicate eyelid tissues that would be required over many years.

In my experience a procedure called a Trans-conjunctival Blepharoplasty with fat grafting described in the link below  provides a permanent solution for Hollow eyes and dark circles under the eyes.

Tear Troughs

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Tear troughs can be corrected non surgically with fat or fillers line Belotero, Restylane or Juvederm.  The surgical option would entail placing your own lower eyelid fat into the tear trough using an approach on the inside of your eyelid.  There will be no scar on the outside and the incision heals by itself without any sutures. Both options are safe and effective. 

Theodore Diktaban, MD, FACS
Manhattan Plastic Surgeon
4.0 out of 5 stars 28 reviews

Lower eyelid bag treatment options

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Generally, there are a few options to improve the appearance of the lower eyelids, eye bags, or dark circles. First option includes basic skin care, tretinoin, and/or chemical peels. This nonsurgical method helps improve the skin quality, reduce pigmentary changes, and improves overall appearance of the lower eyelid & cheek areas.

Second more advanced option is an injectable filler or fat to plump up the area below the bag. Fillers are made of material that is slowly removed over time. Hyaluronic acid facial fillers such as Restylane or Belotero have been used to help smooth this area. Facial fillers treatment is performed in the office vial local anesthesia and with long-lasting results.

The last option, and also the most aggressive, is eyelid plastic surgery. Cosmetic surgery of the lower eyelid may remove or reposition fat in the eye bag area, and possible remove some sagging skin. Plastic surgeons typically don't recommend cosmetic eyelid surgery in young patients as the first option. However, each patient is unique and circumstances may vary. Age alone is not a determining factor if a person is a cosmetic surgery candidate.

Only after a comprehensive evaluation can a specialist help determine appropriate options for you. Best of luck.

Dr. Chaboki

Houtan Chaboki, MD
Washington DC Facial Plastic Surgeon
4.9 out of 5 stars 89 reviews

Permanent filling of tear trough hollows

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Thank you for your question.  The tear trough hollows can be filled by means of surgical and non-surgical options.  Surgical options include blepharoplasty with placement of tear trough implants (for deeper deformites) or fat injections or fat redistribution (for shallower deformities).  Injectibles include hyaluronic acid fillers (Belotero, Juvederm, Restylane) all of which are temporary.  For a cost effective quick fix, you may inject Artefill which is a permanent filler.  There are no take backs with this off label usage of this product, so you must go with someone with a lot of experience injecting this area when using this product.

Gilbert Lee, MD
San Diego Plastic Surgeon
4.6 out of 5 stars 25 reviews

Best treatment for tear trough / under eye hollows.

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It's hard to tell without photos but you're options can include surgery or non surgical procedures.   Surgical options include lower lid blepharoplasty with either fat repositioning or fat grafting.  Non surgical options include hyaluronic acid injections (ie Restylane).  A complete examination by a surgeon who specializes around the eyelids can help give you the best recommendation for you. Good luck.


Treatment for tear trough

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Without viewing photos or knowing your age, I cannot make an accurate assessment on your issues.  But, there are several ways to treat the tear trough deformity depending on several factors.

If you have good skin tone, are younger, and only have a concavity in the tear trough area, you can treat the deformity with fillers.  I like to use Belotero, which is a hyaluronic acid filler, under the eyes as I does not cause the tindel affect which is the blueish discoloration under the eyes which can form from using hyaluronic acid fillers.  You can also use fat grafting to the area but is a little more surgical in nature with a longer downtime.  I have noticed that the hyaluronic acid fillers can last up to several years under the eyes.

Another option if there is a component of loose skin is to perform a lower blepharoplsty with repositioning of the fat pockets.  This can be done with skin resection through a transconjunctival approach or with an incision below the lower lid lashes if skin needs to be resected.  If there is significant infraorbital hollowing, then you may also need a midface lift at the same time.  Good Luck and find a surgeon that can do all of the above procedures so you are getting the right choices.

Jeffrey LaGrasso, MD
Miami Plastic Surgeon
4.4 out of 5 stars 114 reviews

Under eye hollows and filling in the tear trough

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Dear LisaandLove,

  1. You have 2 options that would look great (depending on your exam) - Restylane and fat transfer (with or without removing the fat underneath the eyes)
  2. If you do not want surgery and are a good candidate, then Restylane under the eyes works amazingly well, there is a video attached demonstrating the non-bruising technique.  It will last 1-2 years and looks natural
  3. The more permanent option is fat transfer which can last around ten years and it also looks great, it just requires some light sedation anesthesia and more downtime with swelling

Best regards,
Nima Shemirani

Nima Shemirani, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 85 reviews

Lower Blepharoplasty and Fat Redistribution is an Excellent Option for Tear Trough Deformity

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In my opinion, lower blepharoplasty, release of arcus marginalis and fat redistribution to correct the tear trough deformity gives  a long lasting and consistently good results.

Eric In Choe, MD
New York Plastic Surgeon
4.6 out of 5 stars 51 reviews

Tear trough issues

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I prefer Restylane injections to surgery for under eye hollowing. The procedure is much cheaper than surgery and typically lasts 1-2 years or more.

Mitesh Kapadia, MD, PhD
Boston Oculoplastic Surgeon
4.9 out of 5 stars 182 reviews

My treatment of choice for the "tear trough" is blepharoplasty with midface lift.

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It is a procedure I published last year in the journal Plastic and Reconstructive Surgery. You can see some before/after pictures at my area here on RealSelf and also at my website BeautifulEyes.com


Jeffrey Schiller, MD
Edison Oculoplastic Surgeon
5.0 out of 5 stars 12 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.