What is the best treatment for undereye hollows (tear trough deformity)?

I'm a 26 year old female with genetic undereye hollows (I've had them since I was 10). I don't have dark circles, puffy eyes or eye bags. But I have almost no fat under my eyes and deep tear troughs. It seems to be getting worse lately (aging process?). I've done research and I'm confused about all the options: restylane/other fillers, fat transfer, blepharoplasty, arcus marginalis release, tear trough implants. Which gives the most improvement with the least risk?

Doctor Answers 6

Best Treatment for Tear Trough Deformity

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
I agree with the doctors who have responded to your question thus far. 

Of all the options discussed, the treatment that will give you the most improvement with the least risk is the new filler, Beletero.  Surgery may not be needed, and in any case you will see improvement, which can last as long as a year or more in this area.

Restylane is also used under the eyes with great results, but the advantages of Beletero include that it spreads like spackle under the skin, swells the least, and never give a blueish tinge to the skin as Restylane can if it placed too superficially.  It also is a treatment that is reversible if you do not like it for any reason. Although I have never had a patient who wanted to go back to the way they looked before treatment, it may make you feel more comfortable to know that you are not doing something with permanent effects.

(You can see my other answers about Beletero if desired.)

New York Dermatologist
4.7 out of 5 stars 10 reviews

You may be a candidate for either dermal filler or fat transfer

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
The tear trough area can be one of the more challenging areas to treat and many options are available. With that being said, I recommend consulting with a board certified facial plastic surgeon who can evaluate your anatomy and customize a treatment plan to best fit your needs.
Options in this area include dermal fillers (either restylane or belotero), possible fillers to your cheek area (radiesse or juvederm) to smooth the transition between your eyelid and cheek, or fat transfer. All procedures in this area include some risk so be sure to discuss your concerns in detail with your surgeon

James Chan, MD
Portland Facial Plastic Surgeon
4.9 out of 5 stars 60 reviews

What is the best treatment for under eye hollows (tear trough deformity).

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
You have done your research so you know there are several surgical and nonsurgical options. You would be best served by consulting with a board certified surgeon who has expertise in eyelid surgery and can examine your lids and explain what the. Est options for you are.

Suzanne Kim Doud Galli, MD, PhD, FACS
Washington Facial Plastic Surgeon

Treatments for Tear Trough Deformity

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Thank you for your question. Pictures would be helpful.

For a prominent tear trough deformity, fillers or fat transfer can camouflage the problem, providing a reasonably good result.  Fillers are temporary; fat transfer can be unpredictable.

Lower lid blepharoplasty with septal release and reset at the arcs marginalia can provide long lasting, essentially permanent, correction for this condition in the right patient.

All procedures of the lower lids, including injections, carry some inherent risk.

To be sure what might be best for you and to discuss the benefits and risk in great detail, see two or more board certified and experienced plastic surgeons in your area for a full and complete evaluation.

I hope this helps.

J. Jason Wendel, MD, FACS
Nashville Plastic Surgeon
5.0 out of 5 stars 221 reviews

Nonsurgical is the place to start.

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
For many people, for a very long time, under eye fillers will get the job done for a very long time.  The product I like for this is Restylane.  Treatment is not perfect.  It is a bit fussy and you need a fussy injector who knows how to get the best result from the treatment.  This might require adjustments after the treatment.  For this reason, it is ideal if you can find an injector who is close to home.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Treatment options for under eye hollows

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
There are several treatment options for under eye hollows, as you mentioned.  I would recommend trying a filler first (such as Restylane).  This would be the simplest treatment option and you could always try one of the more invasive options later if needed.  

Michael I. Echavez, MD
San Francisco Facial Plastic Surgeon
4.5 out of 5 stars 18 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.