I have grooves under my eyes. Are they eye bags, tear troughs or festoons? What is the best treatment? (Photo)

I have grooves sitting fairly low under my eyes that don't go away. I did some background research and I honestly can't tell if they are under-eye bags, tear troughs, or festoons. I have heard it could be sinus related as well. I know that treatment varies depending on the condition. I am 24 years old and made the poor choice of tanning excessively when I was a teen, but have always taken great care of my skin and avoid sun exposure as much as I can now. I feel like it's too early for this!

Doctor Answers 5

Tear trough, lower orbital rim hollow and malar ligament

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Hi eyehelp121,

Tear trough

The first 1 inch of the diagonal groove from the inner corner of the eye is called a tear trough.  Although there is a slight bulge above the tear trough, I would not define your lower eyelid bulge as an eyebag.  A very small volume of Restylane should be able to hide the lower eyelid bulge to blend it smoothly to the upper cheek by your nose.  I have much more extreme examples of true eyebags which I was able to blend smoothly to the upper cheek.

Lower orbital rim hollowing

The hollowing around the outer rim of the eye is not called a tear trough.  If there is a slight concavity or almost a fingerprint sized depression between the outer eyelashes to the cheekbone, this can be filled to appear smoother from the eyelash to the cheekbone.  This can give a higher and fuller cheekbone appearance by reducing the concavity under the lower eyelashes.

Malar ligament AKA Cheek ligament

A continuation of the tear trough as is travels diagonally across the cheek is called the malar ligament.  If the cheek and lower eyelid tissues are overflowing the ligament, then you can call it a festoon.  Since it is flat above and below the ligament, I just call it a malar ligament.  I like to fill deep below the malar ligament to pop-out the slight indentation of this area of the cheek.

Completing the Triad => Apple cheeks.

Using relatively small volumes of 1-3 cc's (1 cc is the same as 1/5th of a teaspoon) smoothing out the concave areas under the lower eyelash line can make the cheeks blend more seamlessly to the the lower eyelash line, without creating a bloated, pillow face appearance.

I like Restylane for these areas and using a microcannula to inject to reduce the chance of bruising and allows more delicate sculpted result.


Dr. Yang

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New York Facial Plastic Surgeon
4.8 out of 5 stars 35 reviews

Restylane workds great for tear troughs

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from your photos is looks like you have some volume loss which may be in some way related to tanning, but more likely you look like someone in your family. tear troughs and some volume loss in the upper cheek, which it also looks like you have, tend to have more to do with underlying bony structure and soft tissue changes. as long as you don't have allergies which cause swelling around the eyes you would be a great candidate for Restylane injections.

Katherine A. Lane, MD
South Burlington Oculoplastic Surgeon
5.0 out of 5 stars 13 reviews

Tear Trough Injections with Restylane

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Hi EH.  You are a PERFECT candidate for Restylane injections under the eyes.  It's not likely that the grooves are a result of tanning, at least at your young age.  It's more likely they are a genetic issue and can be fixed easily using Restylane.  Find a talented injector in your area that can show you before and after pictures of someone in your same situation.  We would recommend 2 CC's of Restylane to fill the void under the eye and it would likely last about 9-12 months.

For before and after pictures of the tear trough injection procedure, click on the link below.

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

Tear troughs

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You do have a little prolapsed fat, but mostly you have a deep tear trough from a lack of volume.  You also have a prominent malar fat pad whereby you can see the outline of the pad through the skin.  You should try adding some volume to the tear trough to smooth the transition from the cheek up to the lid.  Belotero or restylane are your best choices for filler in this area.

John J. Martin, Jr., MD
Coral Gables Oculoplastic Surgeon
5.0 out of 5 stars 31 reviews

Grooves under eyes

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Based on your photos it looks like the main problem is hollowing in the area of the tear trough and upper cheeks. I think you could benefit from filler injections in this area. The goal is to blend the eyelid-cheek junction, which should lead to a more youthful, less-tired appearance.

Mitesh Kapadia, MD, PhD
Boston Oculoplastic Surgeon
4.9 out of 5 stars 183 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.