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

Hi, I'm 22 and have had noticeable tear troughs since I was 18, at least. I was wondering if there's anything I can do to diminish them without jumping to fillers or surgery... drinking more water, retinol cream, etc? I have two pictures taken at different days and in different lightings to show that they're 'permanent' and not just a passing thing. Thanks!

Doctor Answers 16

More volume to build the cheek up higher and hide the tear troughs

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.


Dr. Yang
P.S. There is a new feature on Realself, which is the "Follow" button. It is similar to the "Like" button on Facebook. If you like my response or any of the doctor responses while you research on Realself, you should "Follow" them. You will get email updates, when the doctors you follow post any new answers to questions, post new photos, or have any new reviews.

New York Facial Plastic Surgeon
4.8 out of 5 stars 34 reviews

Young woman with tear troughs

Thank you for your pictures. Millie invasive things they can be down it would include could sunscreen SPF 30 or greater, Retin-A and a good moisturizer. You may need to add a bleaching components such as hydroquinone to help with the slightly darkened skin of the lower eyelid. This will improve the overall texture and health of your skin. I do think that fillers would be helpful in the tear trough to help soften that transition from your cheek to your eyelid.

Fillers or surgery

The tear trough is caused by combination of the decent of the cheek fat and the protrusion  (sticking out) of eyelid fat.  Subtle cases can be treated with fillers like Belotero, but this is a tricky area.  It should only be injected by a experienced physician, and probably with a blunt cannula.  Eventually you will probably need surgery, a lower eyelid blepharoplasty with a fat transposition.  I have seen patients who had this problem from a very early age. I have attached link.

Stuart H. Bentkover, MD
Boston Facial Plastic Surgeon
4.5 out of 5 stars 25 reviews

Belotero Balance Works Well For Tear Troughs In Young People

Proper diet, exercise, water consumption, sun protection (including broad-brimmed hats), daily retinoids and alpha hydroxy acids, and sunglasses are all great ideas in general for ongoing skin protection and skin maintenance. Unfortunately, I think they will do little to significantly improve the tear trough area, as this is more due to volume depletion below the skin surface--which is why surface treatments, like microdermabrasion, superficial chemical peels, fractional lasers, IPL, etc are also all unlikely to play any real beneficial role.

Volume loss requires volume repletion, which means that a filler, like Belotero Balance, placed slightly below to buttress the lower eyelid as well as directly within the tear troughs would appear to be a good option in this particular case. I prefer Belotero, since it has little or no tendency to give rise to the unwanted bluish Tyndall Effect when injected superficially within the delicate skin below the eyes. Injections in this region should only be performed by a board certified aesthetic physician with experience and expertise in treating the periorbital region. And be sure to ask to see befores and afters. 

Nelson Lee Novick, MD
New York Dermatologic Surgeon
4.9 out of 5 stars 30 reviews

Improving the tear troughs

I think you would do particularly well with tear trough fillers such as restylane or juvederm. That said, wearing SPF 30 every morning, sunglasses, and using a retinol or collagen cream under the eyes can provide some benefit too. Best to speak with your dermatologist to see the best options in your particular case. I don't think surgery is necessary at all in your case.

Benjamin Barankin, MD, FRCPC
Toronto Dermatologic Surgeon
4.8 out of 5 stars 53 reviews

Well-performed injectable filler treatments may be considered to improve your under eye grooves.

Your under eye grooves are the hollows between your lower lid "bags" and cheeks. In our practice, we prefer to use Silikon-1000 an off-label filler for permanent results.

You may benefit from consulting several reputable specialists so you could see what might be best for you.

Hope this helps you.

Dr. Joseph

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 421 reviews

Treating dark circles under the eyes and the tear trough deformity

Avene makes a great combination eye cream with Retin A that is available on my website which would be helpful. I recommend filler with Restylane or Belotero injected by an experienced physician. Fat grafting can cause reactive hyperpigmentation that can worsen the appearance of your eyes, and it may not survive. Less commonly it can increase in size with weight gain, causing unsightly protuberances. I would also consider transconjuctival lower lid blepharoplasty to repostion some of the fat causing the lower lid bags into the tear trough area.

Edmund Fisher, MD
Bakersfield Facial Plastic Surgeon
4.6 out of 5 stars 13 reviews

Restylane for Under Eye Injections

Hi Adosia.  You are an excellent candidate for tear trough injections.  We prefer Restylane and have treated patients as young as 18 for your situation.  The reason is that, in some patients, genetics, rather than age, causes the tired appearance below the eyes.  Restylane adds volume back where needed, softening the appearance and helping you look less tired.  

See examples of Los Angeles and Orange County, CA patient before and after pictures for Restylane injections under the eyes at the link below.  

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.4 out of 5 stars 7 reviews

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

I prefer Belotero-Balance HA filler for tear trough deformities. Plus vit E/K- Retinnol creams. Seek experienced injecting doc... 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 174 reviews

Tear trough problem

Your pigment causes the tear trough area to look deeper and a hydroquinone or similar product may be helpful. If not I would recommend fillers such as Juvederm or Restylane . They are reversible and the only noninvasive treatment that will correct your concern .

David F. LaPatka, MD
Santa Barbara Facial Plastic Surgeon
5.0 out of 5 stars 2 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.