Tear Trough Treatment, Sunken Eye Treatment
Tear trough “deformity” is actually a very a common problem in the population. Tear trough relates to an area of hollowness UNDER the eyes (along the lower bony orbital rim and upper cheek), which is usually worse medially (close to the nose) and tapers off laterally (away from the nose). It is much more common in thinner faces but it also has a lot to do with genetics as some are much prone to it. This area of hollowness of lower eyelids creates what is called “dark circles” under eyes due to lighting effect (shadow), giving tired eye appearance and/or sunken eye appearance.
At times, there can be concurrent under eye bags above the tear trough area, which can make the dark circles even worse.If the under eye tear trough deformity (hollowness) is mild, it can usually be covered with makeup but often makeup is not enough. Along the same lines, there are literally hundreds of topical products on the market that are promised as a cure for under eye dark circles but there are either not effective or merely act as a moisturizer to temporarily (few hours) plump the hollow area and reducing the dark circles.
If the under eye tear trough deformity (hollowness) is mild, it can usually be covered with makeup but often makeup is not enough. Along the same lines, there are literally hundreds of topical products on the market that are promised as cure for under eye dark circles but there are either not effective or merely act as a moisturizer to temporarily (few hours) plump the hollow area and reducing the dark circles.There are various effective treatment options for the tear trough area to reduce or eliminate dark circles and improve sunken eye appearance. Each has its own advantages and disadvantages and the best treatment choice depends on the patient’s specific anatomy and desired goals. The treatments include hyaluronic acid gel filler injection, fat transfer (injection), tear trough implant, and lower blepharoplasty (with fat repositioning), or a combination of the above treatments.
There are various effective treatment options for the tear trough area to reduce or eliminate dark circles and improve sunken eye appearance. Each has its own advantages and disadvantages and the best treatment choice depends on the patient’s specific anatomy and desired goals. The treatments include hyaluronic acid gel filler injection, fat transfer (injection), tear trough implant, and eyelid surgery (with fat repositioning), or a combination of the above treatments.It is also important to mention that hollowness in UPPER eyelids can further exacerbate (worsen) the dark circles around eyes and sunken eye appearance. Therefore, treating the upper eyelid area is also beneficial and complementary to under eye treatment. Treatment for upper eye hollowness includes hyaluronic acid gel filler injection and/or fat injection.
It is also important to mention that hollowness in UPPER eyelids can further exacerbate (worsen) the dark circles around eyes and sunken eye appearance. Therefore, treating the upper eyelid area is also beneficial and complementary to under eye treatment. Treatment for upper eye hollowness includes hyaluronic acid gel filler injection and/or fat injection.
HYALURONIC ACID GEL FILLER INJECTION
Hyaluronic acid gel filler products (Restylane, Belotero) can safely and effectively be injected under eyes to treat tear trough deformity and hollow sunken eyes. The procedure is done with the patient sitting up in the office. The procedure takes a few minutes to complete and it practically painless. There is bruising/swelling that lasts a few days. Most importantly, the effect is IMMEDIATE, PREDICTABLE, and NONINVASIVE. In addition, the effect lasts 1-2 years.
As with any cosmetic procedure, technique is extremely important to achieve the desired effect with natural appearance. If the filler is injected in the eyelid too superficially, it can give puffy bluish discoloration (aka Tyndall effect). The filler needs to be injected deep (on the bone) and in the lower eyelid area, NOT in upper cheeks. Other important factors include type of filler injected and the amount injected. It is critical to be conservative with the amount of filler injected as too much filler can again create unnatural puffy bluish discoloration. Another advantage of hyaluronic dermal filler is that there are reversible by using revering enzyme ‘hyaluronidaze.’ (Please refer to Eyelid Filler Injection for more details.)
FAT TRANSFER INJECTION
Fat can be harvested from other parts of the body (usually the belly or medial thighs) and transferred and injected to treat tear trough area (dark circles) and hollow sunken eyes. The fat is taken using manual suction to avoid damaging the fat cells. The procedure is done under local anesthesia or conscious sedation. The recovery is painless but there is bruising/swelling for 7-10 days. The great advantages of eyelid fat transfer are the following: 1) fat is natural; 2) the effect is long lasting or permanent. The main disadvantage of fat is that the result is unpredictable as not all the transferred “takes” or survives. It is variable among different individuals. It takes about 3 months for the transferred fat cells to “take” or survive. Any residual hollowness can receive “touch-up” filler injection, if desired.
(Please refer to Eyelid Fat Transfer for more details.)
TEAR TROUGH IMPLANT (INFRAORBITAL RIM IMPLANT)
A permanent treatment to treat tear trough hollowness is tear trough implant (Infraorbital Rim Implant). Using hidden incision inside the lower eyelid (transconjunctival), the implant is inserted to fill the tear trough deformity and shallow orbital rim or those with maxillary hypoplasia. It also effectively improves sunken eye appearance. The procedure is usually done under conscious sedation. Although a safe procedure, tear trough implant is obviously a more invasive procedure than eyelid filler or eyelid fat injection. However, the effect is permanent and natural as the small tear trough implant blends in with surrounding cheek bone and helps treat negative orbital vector or eye prominence too. The implant is made of solid silicone which is inert and never has to be changed but can be removed if ever desired but that is extremely uncommon. On the other hands, if there is residual hollowness that remains after tear trough (orbital rim) implant, then hyaluronic acid gel can still be used to provide optimal result with smooth under eye appearance.
Removal of lower orbital rim (tear trough) cheek medpor implant in a woman who was unhappy about its appearance. It was done using scarless inside eyelid approach. It’s removal was very difficult as medpor gets scarred to surrounding tissue. Silicone orbital rim implant would have been much easier to remove.
Male patient with congenital bulging eyes and lower eyelid retraction and significant under eye bone deficiency underwent cosmetic orbital decompression, lower eyelid retraction surgery, and lower orbital rim tear trough silicone implant (Infraorbital Rim Implant) placement.
Animation video showing the placement of infraorbital rim implant and the change it makes. Important to use transconjunctival technique to preserve eyelid function with quicker recovery.
Before & After Photos
*See disclaimer below
27 year old transgender female, underwent eye transformation almond eye surgery including lower eyelid retraction surgery with canthoplasty, infraorbital rim silicone implant, orbital decompression bulging eye surgery, and upper eyelid filler injection. Before and 1 month after surgery photos are shown.
Woman who was unhappy about her eye shape and negative orbital vector and eye asymmetry, underwent eye plastic surgery including cosmetic bulging eye orbital decompression, infraorbital rim silicone implant, lower eyelid retraction surgery with canthoplasty, right upper blepharoplasty and left upper eyelid filler injection. Note more almond shaped and symmetric eye appearance in the after photo taken 1 month after almond eye surgery.
34 year old female, with bulging eyes from Graves disease, underwent combined orbital decompression surgery plus lower eyelid retraction surgery plus orbital rim (tear trough) implant placement. Before and 6 weeks after surgery results are shown. You can see her video testimonial on our website testimonial page and her surgical video on specified procedures.
Young man, complained of inherited lower eyelid retraction with sclera show and promiment eyes or negative orbital vector, underwent cosmetic orbital decompression plus lower eyelid retraction surgery plus orbital rim silicone implant. Before and 3 months after eye plastic surgery photos are shown. Note improved eye appearance in both front and profile views
LOWER BLEPHAROPLASTY WITH FAT REPOSITIONING
Often, there is inherited or age-related prolapsed fat under eyes (“eye bags”) which worsen the appearance of dark circles and tear trough hollowness. If there is excess fat bags present, then a great minimally invasive surgical option that provides long-lasting or permanent result is lower blepharoplasty with fat repositioning where the existing fat bags are repositioned/redistributed to fill in the hollow area of the tear trough deformity, giving smooth under eyes. The procedure is done under either local anesthesia or conscious sedation with painless recovery. As with any cosmetic procedure, it is critical to achieve natural outcome and avoid the dreaded surgical look and avoid any unwanted complications such as lower eyelid ectropion or retraction. Hence, it is important for lower blepharoplasty to be performed using hidden inside eyelid incision (transconjunctival) which is scarless and stitchless with quick recovery. (Please refer to Lower Blepharoplasty for more details.)
39 year old female, complained under eye bags and dark circles, looking tired. She underwent transconjunctival lower blepharoplasty with fat redraping and skin pinch excision, to improve both the eye bags and dark circles (latter due to hollowness from tear trough deformity). Before and 2 months after cosmetic lower eyelid surgery photos are shown.
51 year old female, complained of looking tired and older due to saggy hooded upper eyelid and under eye bags and dark circles. She underwent upper blepharoplasty (eyelid lift), lower blepharoplasty (transconjunctival with fat repositioning and skin pinch removal) and lateral pretrichial brow lift (using temple hairline incision). Before and 3 months after cosmetic eyelid surgery photos are shown. Note natural rested eye appearance.
Get Effective Tear Trough Treatment
To learn more about what treatment is right for you, contact Dr. Mehryar (Ray) Taban today through an online contact form or by calling (310) 499-2565. An information consultation can set you on the right path and effective treatments today.
Next, read about Eyebrow Lift.
*Disclaimer: Results vary from patient to patient. Results are not guaranteed.