How to reduce deep tear troughs? (photo)

Question

I'm 27 years old and within the last two years I have developed these dark hollows under my eyes. No amount of colour correcting concealer properly masks them. I've read that restylane fillers can be a temporary solution for this problem, but I also read that they can cause nodules and skin color changes. I would like to know how common this is and/or what other methods of treatment could help reduce my tear troughs.

Kian Karimi, MD, FACS · Answer

Thank you for posting your question and photos. You seem to be a great candidate for tear trough fillers to restore lost volume and disguise the bags that are beginning to form. In my practice, I like to use the hyaluronic acid filler, Restylane, to treat this area. I also prefer to use the microcannula technique when injecting fillers, which eliminates the risk of bruising and provides a very even and natural looking result. In this location, filler can last up to 1 year, at which time the procedure can be repeated to maintain results. In the future, you may want to consider the longer term treatment option of a lower blepharoplasty with fat transposition. This procedure involves redistributing the fat pads under the eyes to act as an auto filler.  I recommend consulting with a board-certified specialist who is experienced in both injectables and surgery in order to learn more about which procedures are right for you.

S. Larry Schlesinger, MD, FACS · Answer

Thank you for your excellent question and providing us with a photograph of the problem.Your deep tear trough is exaggerated in its appearance secondary to the protruding orbital fat just above the trough.  That orbital fat protrusion is due to a weakness in a lower eyelid tissue known as the septum orbitale.  The septum orbitale breaks down in different people at different times based on their genetic makeup.  Once this fat starts protruding, it will only get worse over time.  Injecting anything into the tear trough (which is the visible orbital bone and periosteum secondary to orbital skin laxity) is not only a temporary bandaid, but as the injectible dissolves, it leaves a visible dent which is often asymmetric and difficult to replicate on each injection.  The gold standard for correcting your tear trough would be lower eyelid blepharoplasty with minimal resection of the protruding orbital fat and tightening of the lower eyelid orbicularis muscle to bolster the degenerating septum orbitale by tightening said muscle.  Once this surgery is done and if the tear trough is still visible, then Voluma injected below the orbital rim will correct the tear trough by pushing periorbital tissue into the trough if any remains after lower eyelid blepharoplasty with muscle sling.I highly recommend you seek consultation with at least three core Board Certified plastic surgeons experienced in lower lid blepharoplasty with procedures that tighten the orbicularis muscle.

Brett S. Kotlus, MD, MS, FACS · Answer

Fillers such as Restylane are effective at disguising under-eye bags by filling in the hollows below them.  They generally last about a year and they are reversible. The alternative is lower eyelid surgery to reduce the size of the fat pads and to shift them into the hollows.  Surgery lasts significantly longer than fillers. See my link below for an infographic that provides a more in-depth discussion of fillers vs. surgery for eye bags.

James R. Gordon, MD, FACS, FAAO · Answer

Thank you for asking your question. Restylane is very safe to hide mild bags and improve tear troughs when used by an expert in this area. Your bags should be evaluated in person by an Oculoplastic Surgeon, because they might be too prominent for fillers.  Good luck,

Jason Emer, MD · Answer

The eyes are best treated with fillers, lasers, microneedling/PRP and skin care if you want to avoid a surgical approach.  Best, Dr. Emer.

Mehryar (Ray) Taban, MD, FACS · Answer

You have both under eye bags (fat prolapse) and crease/hollowness below the bags.  Best option is lower blepharoplasty (transconjunctival approach with fat repositioning) where the bags/fat is repositioned to fill the hollow part (see video below). Other less effective options include filler injection and fat injection.

Joel E. Kopelman, MD, FACS · Answer

Hello, thank you for your question. An option that you can consider is the use of HA fillers. I usually use Belotero Balance for areas around the eyes as it is similar to the naturally occurring hyaluronic acid molecules that are naturally found in your skin and so it will blend into the natural contours of your face. This will last for a year or maybe more, and differs in each case.A more permanent solution would be a lower lid blepharoplasty which is a surgical procedure. If you are certain of the result you want to achieve, this will be a good long term solution.

Paul Nazemi, MD · Answer

Thank you for your question.  Based on your photo, the lower eyelid bags are caused from herniation of the lower eyelid fat pads.  Definitive treatment is the surgical removal or repositioning of the fat (i.e. blepharoplasty).  Temporary treatment includes the conservative use of dermal fillers in the area to camouflage the bags and to create a smoother contour.  See a specialist for a comprehensive examination and to learn more.  Best wishes.

Camille Cash, MD · Answer

Thank you for your photo and your question.  You may consider lower blepharoplasty surgery which targets the lower lid area, smoothing the "bags" that concern you and taking up any extra skin.  The result is a smoother, contoured look.  Visit with a board certified plastic surgeon in your area to learn more.

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