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What is the best treatment for tear trough hollowness?

Aesthetic Medicine Skin, Hair & Nails

I am 41 years old, and I have dark under eye circles with tear trough and some hollowness showing up on photos. What is the best treatment for tear trough hollowing? (For example, I'd appreciate advice on whether Rejuran or other aesthetic treatments will help the most).

DOCTOR’S ANSWER (4)

Dear Sarahlee,

Thank you for your discerning question. Not many patients know about the tear trough. There are many causes of dark eye circles and tear trough hollowness is one of them. To be able to understand the treatment options for tear trough hollowness, we need to first understand the anatomy of the tear trough.

The tear trough ligament is a specific anatomical structure that is formed by a stout ligament located in the inner lower quadrant of peri-orbital region. With aging, the eyebags may protrude over this ligament causing the formation of shadows over the tear trough giving rise to a perception of hollowness and aging. Some patients have genetically retruded facial skeletons and the lack of support in this region can also aggravate the hollowness and cause dark eye circles.

Injectables such as fillers and botox can help to camouflage mild tear trough hollowing. The injection of fillers is relatively painless and takes about 15 minutes and it can camouflage the tear trough, restoring a youthful appearance. However, it does not “cure” the hollowness, it merely attempts to camouflage it by filling the overlying skin.

This technique is useful for mild cases of hollowing. However, I caution the use of fillers for more severe cases as the may cause more deformities. Structural fat grafting is another option which attempts to do the same but offers a more permanent solution. Once the fat engrafts, the results will be permanent. Fat grafting can also improve the quality of the overlying skin and rejuvenate the skin. 

In the last decade, the philosophy of treatment and rejuvenation of the lower eyelids has evolved as we have a clearer understanding of the tear trough anatomy. The only treatment that can remove the tear trough hollowness is to surgically disrupt the tear trough ligament.

The lower eye bag fat is then carefully redrapped over the orbital bone, over the tear trough area and into the cheek to permanently obliterate the tear trough hollowness giving a less tired and more rejuvenated appearance. However, release of the tear trough ligament via a lower blepharoplasty incision is not a procedure without risks and care must be taken to ensure a good surgical outcome. 

I hope this answers your question and clarifies your understanding. A well-informed patient makes a happy patient and a happy patient makes a happy surgeon. Have a great weekend ahead!

0 634 views 13 Oct 2018
Contact Doctor

Hi Sarahlee,

Tear trough deformities often create the appearance of dark eye circles, which can make an individual look tired, listless and give the face a "sunken" appearance.

The true tear trough deformity is a natural consequence of the anatomic attachments of the periorbital tissues. Often, the cause of dark eye circles can be multi-factorial. Changes in skin thickness, laxity, and skin hyperpigmentation also play a role. Thin skin or prominent veins under the eye may also accentuate the periorbital darkening.

For mild to moderate cases, I generally recommend minimally invasive procedures such as undereye fillers, which has minimal to no downtime and does away with the risks associated with surgery and anaesthesia.

While Rejuran has a slight skin brightening and good repairing effect, its main purpose is not to be used as a filler.

I personally like to use the Teosyal Redensity II filler as it contains a unique combination of cross-linked hyaluronic acid and non-cross-linked hyaluronic acid, 8 amino acids, 3 antioxidants, 2 minerals and 1 vitamin. Vitamin B6 and Glutathione in RDII has been shown to make skin fairer and lighter, resulting in lightening of dark eye circles by not only filling up lost volume, but by also lightening of the skin around the area.

In more severe cases, patients may need a combination of under eye and medial cheek fillers to correct the deformity better. At times, I would advise patients with severe deformities and very prominent eyebags to consider plastic surgery.

You may wish to consult a trusted doctor for a more accurate assessment of your condition with discussion of the best treatment regime for you! 

Best wishes,

Dr. Joanna Chan

0 771 views 27 Sep 2018
Contact Doctor

Dear Sarah,


Thank you for your question. Tear troughs or hollowing under the eyes can make you look haggard or tired. I see such conditions quite frequently.

Depending on your facial structure, they can occur in young adults or appear later in life as the bone structure around the eye weakens, causing the fat and skin to lose support. The tear trough or orbital retaining ligament at that position, which attaches from the bone to the skin, remains in place while the surrounding lower eyelid and cheek tissues move downwards and inwards. This forms a depression commonly known as a tear trough.

Tear troughs can accentuate the appearance of dark eye circles as the depression is in shadow.

What is the best treatment for tear trough hollowness?

Tear trough hollowness generally responds well to soft fillers placed into the depression. Soft filler is more suitable for the thin skin in this part of the face and generally causes less swelling compared to harder fillers. The filler elevates the area removing the shadowing, causing the hollowness to abate. I prefer to use a blunt needle (cannula) for this area to reduce the chance of bruising and increase safety. The depth of the filler placement depends on your facial structure but I generally prefer to place a sandwich of filler in both the deep and superficial planes for a more natural result.

Commonly, patients with tear troughs also have sunken cheeks and for a better overall result, I might recommend filler to the cheeks for a more balanced and harmonious look.

For severe cases, release of the tear trough ligament and interposition with filler or fat can be done. The latter is usually done surgically via lower eyelid surgery.

Rejuran is rapidly absorbed and cannot be used to correct tear trough hollowing. 

Do consult a doctor who can assess your facial structure in detail and recommend an appropriate treatment plan!

Hope this helps!


Warmest regards

Dr Wan Chee Kwang 

0 824 views 26 Sep 2018
Contact Doctor

Thank you for your question.

In short, the best treatment for you will depend on the severity of your condition. 

Fillers may be a good option for you if your problem is not severe. Fillers can be temporary such as hyaluronic acid, or permanent, such as fat injection. These treatments can address the dark eye circles as well.

If you problem is more severe, a lower blepharoplasty may be your best choice.

I'd advise you to speak to a plastic surgeon about your options.

Hope this helps.

0 816 views 26 Sep 2018
Contact Doctor
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