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

I have been doing quite a bit of reading on this and there seems to be differing opinions. Looking at my pictures, what do you think would be the best, long-lasting approach? These are genetic, as I have had them my whole life, but now as I am about to turn 37 they are looking much worse. The skin directly in the hollow is now starting to look all wrinkly and crepey. When I look in the mirror it is all I see and the concealer just isn't doing it anymore (not like it ever did).

Doctor Answers 9

Minimally invasive methods to correct the under eye hollows

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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.

Rochester Facial Plastic Surgeon
5.0 out of 5 stars 71 reviews

Fixing tear thoughs hollows

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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

Tatiana Khrom, MD
New York Dermatologic Surgeon

Tear Troughs

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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. 

Craig Mezrow, MS, MD, FACS
Philadelphia Plastic Surgeon

Filler for tear trough

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A good solution for you would be to fill the tear trough with filler product like restylane.  That might be a good start for you based solely on your photos.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Restylane is a great first line option

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

Tear troughs

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As an initial treatment, I would recommend Restylane. It may last for up to a year and give you a a sense of what the non-surgical method can do for you. Given your age, surgery would not be a once in a lifetime endeavor and I'd encourage you to try Restylane first and see if it provides the improvement you're looking for.

Treatment for Teartroughs

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I agree with Dr Delia's recommendations. You may also seek a Facial Plastic Surgeon, or Occulopastic surgeon in your area. The other advantage of HA's is that they can be dissolved should you get a less than expected result. Also, the filler will not improve on the blue hue under the eyes (dark circles). 



Michel Siegel, MD
Houston Facial Plastic Surgeon
4.6 out of 5 stars 113 reviews

Tear Trough Treatment

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Use of HA fillers such as Restylane works very nicely for treatment of tear troughs.  The filler may last 6 months or more and if done carefully works well in this location.  There are surgical options utilizing fat grafts from fatty deposits around the eye.  These techniques may be longer lasting but may lead to some problems with the thiner skin in this area if not done carefully. Consult a board-certified plastic surgeon in your area for further evaluation and treatment. 

Stephen Delia, MD
Boston Plastic Surgeon

Fix tear troughs permanently with silicone

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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. 

Donald T. Levine, MD
Nyack Facial Plastic Surgeon

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.