What is the best treatment for tear trough hollowness?

Doctor's Answer

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!

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