The tear trough deformity (a.k.a. naso-jugal fold) represents the depression underneath the under-eye puffiness. They are absent in most young people and slowly develop in the 30s or 40s. People refer to tear troughs as “dark circles” under the eyes and they are responsible for a tired and worn out look.

Fortunately, modern cosmetic medicine offers options for correcting tear troughs. 

First, we usually consider non-surgical options like injectable fillers. We prefer Restylane for this particular region for its predictability and longevity. Commonly, Restylane lasts 1 year or longer in the under eye regions.

Second, fat transfer (a.k.a. fat grafting or fat injection) is a minimal invasive option for ultra-longlasting effects. Fat is usually harvested from the abdomen or hip region through micro-liposuction. Because only about 10cc of fat is removed, no significant effect develops in the donor region. The fat is then prepared, concentrated and injected into the region of volume loss. We use the micro-droplet technique and the fat is placed deep underneeth the muscle layer. Some bruising and puffiness is always present after the fat treatment; we recommend our patients to plan on a good week of recovery. There is usually no pain.

If aging of the lower lids also warrents tightening of skin and reduction of the lower lid puffiness, advanced lower blepharoplasty may achieve the best improvment. We perform these procedures in the office under local anesthesia with a sedative. Recovery is usually determined by puffiness and bruising afterwards; 10 days is usually sufficient.

Sculptra is one good option for non-surgical volume enhancement. We advise our patients to wait 4 weeks before judging the results; 2 vials of Scultra (1 for each side) is a good start for a subtle enhancement although some patients may require further treatments before they are satisfied with the imrovment. In general, volume enhancements are powerful treatments with a subtle change. Most casual observers will not know why a person looks simply better.

Alternatively, a patient may consider Radiesse, Perlane, or Juvederm Plus. Any of these injectables can achieve a good volume enhancement with moderate longevity of about 9 to 12 months.

Fat transfer is minimally invasive, but it does require a longer recovery if sufficient fat volume is placed. We like it a lot and combine it commonly with most face lift and neck lift procedures. Once incorporated into the facial tissues, fat is durable for years. We routinely prepare our patients for 2 sessions although many are satisfied after the first.

Cheek (malar or submalar) implants deserve consideration. Within one procedure they can achieve a nice enhancement. Cheek implants are inserted through inside the mouth. They need to be placed in the right location for a symmetrical and natural result.