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15 Sep

What is tear trough deformity (under eye hollows) and how to treat it

Tear troughs or under eye hollows are well defined, dark and deep hollows that are located  between the lower eyelid, nose and upper cheek. In youth, no significant separation is typically noticeable between the eyelid and the cheek. However, with the passage of time, resulting from the shrinkage of the bone and the downward slide of the cheek fat pad, the separation is noticeable. 

Most people begin to notice the dark circles under eyes by their late thirties and early forties, however certain individuals who have a family history, notice them in their 20s. In this article I’ll discuss strategies to treat the tear trough deformity, fill the under eye hollows and improve your look.

How are tear troughs/under eye hollows caused?

The under eye area tends to crinkle and billow in small bags and because the skin is so thin, it begins to show the dark blood vessels and muscles below. There is a tough ligament that connects the skin and bone. As the bone shrinks with age, this ligament tugs and pulls the skin deeper making the tear trough groove noticeable. The troughs appear deeper when eyelid fat above the trough is bulging more prominently. This can result in tear trough lines, hollows, dark circles, crinkles and tiny bags.

Treatment option #1: Dermal Fillers

There are several approaches to addressing tear troughs. The most common one is to use fillers to replace volume, raise and smooth the area. Juvederm, Restylane or Esthelis (Belotero) are commonly used and are very effective in camouflaging the tear trough. By restoring volume to the area, tear troughs can be softened and darkness, crinkles and bagginess can be improved significantly in a matter of minutes­. The results are immediate and last 12 – 18 months. Fillers must be used sparingly in the eye area because the tissues are thin and there is a risk of irregularities and visible product. Some patients have mild to moderate swelling after the procedure. At the same time the cheeks can be filled with a filler such as Juvederm Voluma or Modelis for an enhanced aesthetic look.

Treatment option #2: Fat transfer

Some plastic surgeons recommend fat transfer whereby fat is harvested from the hip, thigh or abdomen and injected into the area using a small needle or cannula. With this option there is no scalpel blade, no skin incision and no stitching involved. Fat transfer procedures are done under local anaesthesia in a doctor's office. The fat fills the tear trough in the upper check, under the eye, and feels soft and natural. Since it is your own fat, it is meant to last forever. However, the longevity of fat varies, and it may require a top up in a few years.

Treatment option #3: Surgery

Another option to address tear troughs is surgery. A lower eyelid blepharoplasty (lower eyelid surgery) is invasive than the other approaches and involves a longer recovery but it can offer a long-term correction of the problem. The procedure can be performed with an external incision just below the lash line or underneath the lower lid. There will be some swelling and bruising but both incision locations heal very well. Fat in the area under the eye, or even from the upper cheek, can be repositioned to fill in the hollow, helping to eliminate shadowing and allowing for a smoother transition between the lower lid and upper cheek. The entire area will look youthful. After healing, it can be determined if fat transfer or injection of fillers are also necessary to enhance the look.

There has never been a better time to have cosmetic eyelid surgery

With modern techniques and recent technological advancements, eyelid surgery has become   safe, effective and capable of delivering results that you always wanted with minimal pain, discomfort and downtime. A skilled and capable plastic surgeon who uses modern techniques can offer you better and longer lasting results while the specialist anaesthetist ensures your safety and comfort in a modern hospital.

As with any medical procedure, it is important to seek the advice of a skilled professional capable of addressing your concern. Since each person's anatomy and response to surgery and healing is different, an evaluation by a plastic surgeon can help you explore all options and determine the appropriate approach that addresses your concerns.

How to choose the right plastic surgeon for eyelid surgery

In Australia you should seek out a FRACS Plastic Surgeon. The FRACS Plastic Surgeon has 5 key attributes amongst others:

  1. Is fully qualified in Plastic Surgery including Cosmetic and Reconstructive Surgery
  2. Is trained by the Royal Australasian College of Surgeons ( RACS) which is the only College in Australia authorised by the Australian Medical Council (AMC) to train Surgeons.
  3. Is registered as a Specialist Plastic Surgeon with the National Medical Board of Australia
  4. Is recognized as a ‘Specialist in his or her field’ by Medicare Australia
  5. Is a member of the Australian Society of Plastic Surgeons (ASPS) and the Australian Society of Aesthetic Plastic Surgeons (ASAPS)

If you need additional information to assist you in deciding whether cosmetic surgery is the right option for you, send me a quick email at info@naveensomia.com.au and I will happily assist you.

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Dr Naveen Somia MBBS, PhD, FRACS

Dr. Naveen Somia is a Sydney Plastic Surgeon who listens to his patients, understands their problems and works alongside them to help achieve their aesthetic goals by applying his skills and years of experience in Plastic and Cosmetic Surgery. A published author on Plastic and Cosmetic Surgery, Naveen’s blog is aimed at helping you make the right choices and stay safe in your quest to look your personal best.