A tear trough deformity happens when the soft tissue atrophies near the tear trough.  The skin around the area is thin and it makes the attachment between the orbital rim and the skin begins to look more visible.  It is not dangerous but it makes you look older than you’d like to look.  The orbitomalar ligament keeps the skin and the lower eyelid tightly connected to the rim of the lower aspect of the eye socket.  When we are young, a lot of fat surrounds the ligament and fills in the area beneath the skin underneath the eye.  As you grow older, this fat disappears and the ligament sticks out, becoming too obvious and detracting from the beauty of your eye.

What are the treatment options for tear trough abnormalities?

There are two basic treatment choices you can make.  One includes plumping up the tissue surrounding the ligament with fillers, similar to having fat put back where it belongs.  You can actually take fat from other body areas and inject it, once it is cleaned, back into the orbital trough and lower lid.  The second option is to disrupt the orbitomalar ligament completely by performing a lower eyelid blepharoplasty.  It removes the bags beneath they eyes and removes excess sagging skin.  The muscles are tightened and the lower lid looks better.  Some people choose to have both a lower lid blepharoplasty and a filler is used to maximize their appearance.

Using an Injectable Filler

If you’re in your late thirties to early forties, you might want to consider having Restylane or Perlane injected into the trough area because this can fill out the trough and get rid you of the abnormality.  Both Restylane and Perlane are based on hyaluronic acid and can last for more than a year before you need another injection.  The hyaluronic acid is a natural product so that there can be no allergic reactions.  Because Restylane and Perlane have been so successful, few people choose to have fat injections anymore.  The hyaluronic acid substances have shown better success and are more predictable in the result you get.

Making Dark Circles Look Better

You can make dark circles improve in appearance just by filling in the tear duct trough with filler.  You can also inject filler beneath the sagging dark circles themselves to fill in the tissue and get rid of the dark color.  The filler is not permanent and is reversible.  If too much injectable hyaluronic acid filler is used, a brief injection of hylase, an enzyme, can get rid of the amount of gel you need to get rid of.