What Would Be the Best Approach to Fix my Tear Troughs? (photo)

As a first line option I always encourage patients to try hyaluronic acid fillers such as Restylane to the tear troughs. This can be performed in the office with only two or three injection sites. In fact, I have started to use blunt tip cannulas to avoid bruising in this area. This technique has truly revolutionized my practice as my patients are able to return to work the same day looking rejuvenated without the traditioanlly bruising associated with surgery or fat injections. Typically the results can last a year or greater.

As mentioned previously, hyaluronic acid fillers are a great option to start. It is less expensive than fat grafting [though over the long haul may rack up the vials and cost], and is less risky since it can always be reverse if you don't like the result. The trick is to layer the product deep, on top of bone, to avoid the bluish discoloration of skin since with superficial placement of product.

The crepiness of skin when you smile, will probably not be improved with the Restylane injection however. The quality of skin will be improved with a skin peel, or laser resurfacing.

In fat grafting, proper technique is paramount, since the results will last quite a long time. Thus, a double edged sword.

 

Good luck

A combination of several factors can be responsible for undereye hollowness and pigmentation. A vascular component, thin tissue between muscle and skin, and pigmentary issues contribute to patient dissatisfaction with the appearance of this area.I usually use a combination approach, using Restylane ( a hyaluronic acid filler) via a blunt tipped cannula to fill in the depressions and correct the lack of volume in this area. If there is a bluish discolation prior to treatment, I tint the Restylane with a tiny amount of Radiesse ( a filler that is milky white in color) and this approach typically softens the bluish discoloration present in this area. To address the crepiness of the skin and brownish discoloration, I use laser resurfacing, which significantly improves this concern, and finally, a good vitamin K based under-eye cream completes the treatment protocol.Good Luck

I've studied all the pictures you submitted.  Injecting micro droplets of liquid silicone can erase the tear trough depression.  The added bulk may minimize some of the fine wrinkling noticeable on smiling as well. 

There are surgical and non surgical procedures to improve tear troughs.  These include surgical procedures including eyelid surgery, fat grafting as well as non surgical procedures.  During your consultation and examination with your doctor the options most appropriate for you can be discussed.