Tear troughs - should I get fillers, or can anything be done? (photos)

Hi Adosia,Without resorting to fillers or surgery, does drinking more water and getting enough sleep at least help with the darkness that is shown in the photos?  In general, the natural restoration of volume with a good nights rest is what I am trying to achieve with the filler.  I have had some patients who reported that after not getting enough rest or working night shifts for several months caused the dark circles/tear troughs to become permanent.  I can't really explain why this happened, but I suspect that before their lack of sleep, a good nights rest allowed the tissues along the tear trough to expand with a good nights rest.  With repeated lack of sleep/rest, the skin did not have the opportunity to re-expand, and perhaps the skin got "stuck" that way, literally.  After the skin along the tear trough is stuck down, then a good night's sleep no longer allows it to expand as it did in the past.A lower eyelid surgery will not help with tear troughs.  To remove more fat under the eye, will only make the area look darker.  It is already hollow and concave.  To reduce shadowing of a concave area, it needs to either be flat or convex.  Your options are either fat grafting or fillers.  For patients under 40, I tend to recommend fillers over fat grafting.  Fillers are bio-inert, meaning it is not alive and will not grow with weight gain or shrink with weight loss.  For patients under 40 who are women, there is the possibility that they may become pregnant, and the fat grafted area can actually grow in volume out of sync with the rest of the face with the pregnancy or weight gain.  For this reason, I prefer fillers in particular Restylane.  The main draw back with fillers is that it requires repeated treatments to maintain the result, typically in the 12-24 month range.  The filler naturally dissipates at a very slow rate, not dissimilar to the rate of volume loss with natural aging.  The other benefit is that if for any reason the filler does not look good, it can be dissolved with an antidote called vitrase.  The other recent topic of interest with injectable fillers is potential infection with the filler which is treatable with antibiotics, but once the filler is contaminated with bacteria, it should be dissolved away completely and start over or switch to fat grafting as an alternative.The benefit of fat grafting is that the fat is alive and has a blood supply.  If there is an infection of the fat grafted area (like a pimple) any antibiotics that you take will be able to be delivered into the fat because of the blood supply.  The filler does not have a blood supply so infections are more of an issue.  Interestingly, most temporary fillers have not had an infection issue in the smile lines and lips (which is less clean than other area) probably because it tends to dissolve much faster in either 4-6 months for Restylane or 9-12 months for Juvederm.  In those areas, it probably dissolves before there is a chance for infection.Interestingly, Restylane which only lasts 4-6 months in those areas is lasting much longer in the lower eyelid tear trough area.  If it is lasting 12-24 months or longer, we should be thinking of it as an implant, such as a silicone chin implant, or a silicone tear trough implant, or cheek implant.  Pacemakers and joint replacements are also implants.  If these implants get an infection which does not clear with oral antibiotics or IV antibiotics, most likely the implant has developed a biofilm or a film of bacteria which cannot be "cleaned off" of the implant.  These implants would need to be surgically removed and replaced either at a separate surgery or at the same time depending on the surgeon or extend of the infection.For the injectable fillers, the way to remove this type of "implant" it is to dissolve it instead of surgically removing it.  Depending on how it was injected it most likely will take more than one session to completely dissolve the filler.  The chance of this happening is much lower than 1%.  There has been more discussion of this rare problem in national conferences for dermatology and cosmetic surgery.Hopefully plenty of non-caffeinated fluids daily 1500-2000 cc's daily and a good nights rest will help.  Retin-A directly on the lower eyelid skin can make the skin even thinner and crepier, so it is not recommended.  Skin lighteners such as hydroquinone, which is prescription strength or alternative non-prescription strength skin lighteners can reduce the darkness if it is a pigment issue.  If the darkness is caused by a concavity or groove, these other non-invasive solutions may not help enough.  Smoothing out the groove is usually the solution.Good luck on your cosmetic journey.Best,Dr. YangP.S. 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Hi @adosia. The upper cheek is a major support for the under eyes. So when there is volume loss there, not only do the cheeks reflect this, but the under eye can as well with the development of tear trough and under eye hollows. Addressing the volume deficit in the cheeks with the use of a volumizing hyaluronic acid filler would be a reasonable place to begin. Best of luck, Dr. Nima!

Dark tear troughs like yours can be caused by a variety of factors, including genetics. If this is the case with you, it is doubtful that lifestyle changes, no matter how healthy they might be, would have much of an effect on your tear troughs. I typically perform tear trough filler for my younger patients that want to refresh the eyes. The procedure places small amounts of filler under the eyes to restore subtle volume and minimize the discoloration. I inject this area with a blunt-tipped micro-cannula, because it produces the smoothest result and minimizes swelling and bruising. Choose an experienced, board-certified injector for this treatment who can give you the best possible results.