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Joo Tan
VIP
from Singapore asked a question

How to fix under eye and tear trough hollowing?

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Aesthetic Medicine Skin, Hair & Nails Plastic Surgery

My under eyes and tear trough areas look hollow and deflated. I would like to know what are the best procedures to fix them. 

DOCTOR’S ANSWER (8)
Dear Joo

I hope you had taken time to read through the answers provided and hopefully found a doctor to solve your problem.

I would just like to share my  opinion regarding this problem as this is something that I come across quite frequently in my practice.

Undereye and tear trough depression is usually associated with Aging process although I have seen a fair number of cases which are probably genetic in nature as they are present from an early age.

The undereye area is especially delicate and represents the thinness part of the facial skin. As such it is especially prone to wear and tear and Aging changes.

We now understand that there is a tear trough ligament which is like an extension of the orbicularis retaining ligament (ORL ) . When the ligament becomes lax it is unable to support the structure above it and a depression occurs. Any volume loss in this area either due to fat loss or bone resorption makes the depression worse. This can also result in the appearance of dark undereye circles.

If we can appreciate the cause then any treatment that gives support to this area and at the same time restore volume would improve this problem . Hence the most common treatment would be to inject a HA Filler usually deep along the tear trough depression to “ lift “ it. Superficial injections are sometimes needed to further improve it but must be done with caution and with a soft filler to reduce a sausage shape appearing and the so called “ Tyndall Effect “ which is like a bluish tinge . We are unable to treat the bone resorption at this point in time but there are developments underway to produce a bone filler.

You would need to see a doctor experienced in treating this area to obtain a good result.  Best wishes and good luck .

Consult Doctor
0 22 views 1 Doctors agree 15 Dec 2018

Dear Joo,

Thank you for your question on sunken eyelid. This is a great question and I have seen several patients that have come to see me for this problem. Like the other doctors have mentioned, this may seem like a simple problem which can be solved with a filler injection - but it is not. It is important to understand the underlying cause and correct that first, such as ptosis or droopy eyelid. Injections of fillers around the eyes can also be challenging due to the complicated anatomy and blood vessels around the eye. 

A frame deformity. (https://doctorarchielamb.com/procedures/injections-reduce-wrinkles/frame-deformity)

The youthful upper eyelid does not appear sunken because the contents of the orbit (such as fat) are firm and the eyelid skin is tightlly stretched across the bony socket. Sunken upper eyelids are a result of a hollowness of the upper lid and it gives rise to a characteristic A-frame deformity, which is leads to a tired or aged look.

Some of the conditions that can cause hollowing of the upper eyelid include:

1. Ptosis. A lot of patients do not realise that they have ptosis or that ptosis can lead to sunken upper eyelids. In this group of patients, treatment of the droopy eyelids with Ptosis Correction Surgery will correct the sunken eyelids. This is commonly seen in patients who in their 30s-40s with sunken eyelids.

2. Previous injury to the orbital area or infection.

3. Previous surgery to the upper eyelid, such as excessive removal of fat during upper eyelid surgery

4. Age-related deflation and atrophy of fat in the upper eyelid. In this above 3 group of patients, injection to augment the upper eyelid can correct the A-frame deformity and rejuvenate the appearance of the patient.  Filler injections with hyaluronic acid can be given but this is temporary and for this region, I prefer structural fat grafting as a more permanent solution. However, this may need more than one session to avoid over-grafting and over injecting. Over-injections in this area can definitely cause more problems and it can even cause droopy eyelids as it may interfere with the function of opening mechanism of the eye. In severe cases, an open incision correction is done and a dermal graft or fat transposition is performed to correct the deformity.

I hope this answers your questions!  

Dr. Terence Goh

Plastic Surgeon

Consult Doctor
0 174 views 0 Doctors agree 30 Nov 2018

Dear Joo,

Sunken, depressed under eyes, as well as pigment around under eyes are causes of dark eye circles.

Based on my experience, I will recommend performing a hyaluronic acid filler to fill up the depressed/sunken to give a very natural and refreshed look. 

For fillers around eye areas, a trained doctor with experience is essential to ensure achieving safe, natural-looking results.

The amount of fillers required varies for each person, it also depends on how sunken the eyes are. Generally speaking, it takes only one session to treat dark circles. 

The result for fillers is immediate, it gets better as the fillers integrate with the skin tissues. Fillers result lasts 6 to 9 months and will last longer with repeated treatments.

Hope it helps.

Best regards,

Dr Lam Bee Lan

Consult Doctor
0 666 views 0 Doctors agree 29 Oct 2018

Hi Joo!

A tear trough deformity can cast a shadow on the lower lid, giving the appearance of a dark eye circles and making a person look tired. If there is hollowing of the under-eyes, it is likely that you lack volume in the cheeks as well.

I would recommend tear trough and cheek fillers for a good overall result. A soft filler would be place in the tear trough area, and a harder filler would be placed in the cheeks. Good technique is required to prevent complications such as lumpiness and Tyndall effect (bluish discoloration due to too large or too superficial filler placement).

If your condition is very severe, you may then require a lower blepharoplasty.

Do consult a doctor to find out more!

Hope this helps.

Regards,

Dr Harvey Ho

Consult Doctor
0 753 views 0 Doctors agree 26 Oct 2018

Dear Joo,

A hollow appearance can happen frequently around the eyes, especially on the "under eyes" area. This is a result of bone loss and fat pad sagging. 

I agree with Dr Ho that the best procedure would be fillers in the appropriate areas. Good technique and good products are necessary for a safe procedure and a natural look.

All the best!

Consult Doctor
0 708 views 0 Doctors agree 27 Oct 2018

Dear Joo

As we age we lose fats,collagen ,hyaluronic acids and elastin in the skin.This will lead to thinning of the skin and loss of volume resulting in sunken under eyes and tear troughs.Furthermore eyebags and dark eye circles are frequently associated with tear troughs.This is due to the thin under eye skin which exposes the underlying blood vessels and the melanin that is laid down

Treatment of under eye hollowing and tear trough would therefore involve the administration of a soft hyaluronic acid filler like Restalyne Vital to plump up the hollow restoring the youthful look. Laser toning to lighten the any dark eye circles and HIFU  or RF to tighten any loose skin or eye bags will also go greatly improve the region around the eyes.

Another method that I usually use is to administer PDRN Skin Boosters or anti aging solutions with peptides etc to stimulate collagen and rejuvenate the eye region 

Best Regards

Dr Lim Heng Wei

Consult Doctor
0 691 views 0 Doctors agree 28 Oct 2018

Dear Joo, 

Based on my experience, the best treatment for under eye and tear trough hollowing is Dermal Fillers. 

My preferred type of dermal filler is a hyaluronic acid filler to fill up the volume loss to give a natural and refreshed look. Good brands of fillers include Juvederm, Restylane, Teosyal and Stylage. 

Under Eye fillers are challenging. It's best to seek treatment from an experienced doctor to ensure safe, natural-looking results.

The amount of fillers required varies for each person. Some patients may need 1-2 syringes of filler. 

The result for fillers is immediate. Filler result lasts 6 to 9 months and will last longer with repeated treatments.

Hope that this helps!

Warmest regards,

Dr Justin Boey

Consult Doctor
0 611 views 0 Doctors agree 30 Oct 2018

Dear Joo,

With age, there is resorption of bone and decrease in soft tissue density around the eyes resulting in tear trough hollowness. 

In my practice, I use customised low-viscosity fillers depending on severity and extent of tear trough hollowness. Injecting fillers at the correct depth will yield optimum natural results with no to low downtime (swelling, bruising).

Hope this helps!

Best Regards,

Dr David Deng

Consult Doctor
0 389 views 0 Doctors agree 8 Nov 2018
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