What Is Tear Trough Deformity?

Treatment for Under Eye Hollows

The eyes are often considered to be the most beautiful feature of the face because they are so delicate yet deep. The delicate appearance of the eye is both an advantage and disadvantage. An advantage, of course, because of the way it mesmerises people and a disadvantage because it often is the first to be affected by age, stress, and other factors. 

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What is a Tear Trough Deformity?

A tear trough deformity is a deep line or crease between the upper cheek, lower eyelid, and nose. It gives the eyes a hollowed-out and tired appearance which can be quite difficult to get rid of. 

The tear trough deformity, in some people, is the result of genetics and is present since birth. Of course, it becomes more prominent as they grow up but it has always been present, and getting rid of it is much more difficult for them than for people who developed them later on in life. The latter group suffers from a tear trough deformity, also known as under-eye hollows due to stress, ageing, or weight loss. 

In people who get a tear trough deformity later in life, it is mostly due to loss of volume in the cheeks. This loss is mostly because of either ageing or massive weight loss and it ends up exaggerating the crease below the eye and above the cheek. 

Who is a Good Candidate for Treatment of Tear Trough Deformity?

In order to determine whether a treatment option for tear trough deformity is suitable for use, it is important to analyse the patients’ condition and assess if they meet the eligibility criteria. The presence of the criteria is to make the procedures safe for everyone and ensure that the best results are achieved.

Surgical Treatment 

An ideal candidate for the surgical treatment or blepharoplasty procedure is someone who:

  • Is physically and mentally healthy
  • Is a non-smoker or willing to quit smoking at least six weeks before the surgery
  • Is suffering from tear trough deformity either congenitally, due to ageing or weight loss, or due to negative vector orbit
  • Has realistic expectations from the procedure
  • Is undergoing the procedure for themselves and not to fit into any trends
  • Is aware of the side effects and potential complications that can arise from the procedure, so they are making an informed decision about undergoing the procedure

Injectable Treatment

An ideal candidate for the injectable treatment or dermal fillers is someone who:

  • Is suffering from tear trough deformity
  • Does not have dark circles, transient or persistent
  • Does not have damaged skin around the eyes
  • Does not have thin under-eye skin
  • Is overall healthy and fully aware of the side effects of the procedure

Injectables for Treatment of Tear Trough Deformity

Tear trough treatments are used to reduce the hollowness of a tear trough, as the depth can cause the under eye area to form lines and appear darker as a result of the hollowness. By injecting dermal fillers into the area below the lower eyelids, this non-surgical method will increase volume beneath the eyelids, giving the skin a look that is fuller and tighter than before. With the skin stretched out a bit, fine lines under the eyelids will be minimised, resulting in the appearance of a more youthful appearance. 

When the patient is ready to get the fillers, the area is disinfected in preparation. At this point, the surgeon or technician will also apply a topical anaesthetic cream to numb the area. The fillers are not that painful but this is done to ensure that the treatment is provided with minimal pain. If you are uncomfortable with anaesthesia, you can choose to have an ice bag applied to your eyelids. This will also numb the area. 

The filler will then be injected under the skin near the lower eyelid. While releasing the filler, you will notice that the technician or the healthcare professional is slowly pulling out the needle. Once fully injected, the needle will be removed and the area will be gently massaged. This is done to spread the filler completely. 

The common injectables or dermal fillers used are:

  • Belotero: This temporary filler works for tear trough deformity however, the most common use of this filler is for reducing the appearance of nasolabial folds
  • Juvaderm: This filler is a group of hyaluronic acid fillers that have a multipurpose use. They can help improve the appearance of the entire face by getting rid of fine lines, wrinkles, eye bags, and under-eye hollows
  • Restylane: This filler is composed of hyaluronic acid, a common hydrating ingredient of most skincare products. This filler hydrates and rejuvenates the skin from the inside, and leaves the under-eye hollows looking plump for almost an entire year

Surgical Treatment of Tear Trough Deformity

  • The surgical treatment of tear trough deformity is blepharoplasty or eyelid surgery. Blepharoplasty is a surgical procedure that is performed with the purpose of removing excess skin and fat deposits from the upper or lower eyelid. The procedure will reposition the fat deposits around the lower eyelid to give it more of a plump and rejuvenated appearance. The hollow eye look can be significantly improved with a lower or upper blepharoplasty. 

During the blepharoplasty procedure, the main aim is to correct the appearance of the under-eye hollows. The procedure is excellent for the permanent treatment of tear trough deformity and it is very rare for the deformity to recur after the surgery. However, it is worth noting that this procedure has the longest recovery time amongst the treatment options for tear trough deformity. 

  • Another option for the surgical treatment of tear trough deformity is fat transfer. The fat used is grafted from hips, thighs, chest, or abdomen using a cannula and prepared for fat transfer. Once prepared and filtered, the fat is injected into the under-eye region. The basic principle is the same as dermal fillers, however, the results are much more lasting. 

Since it is fat from the body that is being used to fill the under-eye hollow, the results are the most natural looking and the recovery time is not as extensive as a blepharoplasty procedure. 

Risks and Complications of a Tear Trough Deformity Treatment Procedure

The risks and complications of tear trough deformity treatment depend on the type of treatment applied. The side effects of the dermal fillers as a treatment for tear trough deformity are:

  • Headache
  • Skin discolouration
  • Allergic reactions
  • Persistent pain
  • Swelling around the eye
  • Lumps filled with filler ingredients
  • Granuloma which is a small area of swelling or inflammation around the injection site
  • Infection
  • Vascular side effects such as bleeding or occlusion of an artery
  • Lack of desired results

Certain red-flag complications that often develop 2 weeks after the fillers and warrant immediate medical help are:

  • Worsening bruising
  • Worsening redness or swelling
  • Persistent loss of sensation
  • Extreme pain
  • Severe infection
  • Blurry vision or other vision changes
  • Lumps that are red and painful to touch

The complications associated with the surgical treatment of tear trough under eye hollows are:

  • Infection at the site of surgery
  • Bruising and swelling
  • Change in the shape of the eye
  • Bleeding
  • Haematoma and seroma
  • Lumps
  • Allergic reaction to the anaesthesia

FAQs about Tear Trough Deformity

How do you treat tear troughs naturally?

  • Treating tear troughs naturally is possible if the cause of your under-eye hollows is the result of stress, lack of sleep, or exhaustion. A good night’s sleep and proper hydration are key for naturally treating the under-eye hollows. Some of the other home remedies include the use of lemon juice, raw potatoes, cucumber slices, and almond oil. These ingredients are known for nourishing the skin and hydrating it to make the under-eye region plumper. However, the natural treatment of under-eye hollows only provides temporary relief. For permanent results, natural remedies are just not enough. 

Can tear troughs go away?

  • Yes, tear troughs can go away by managing the causes of the under-eye hollows such as lack of good sleep. They can also go away permanently with the help of injectables that will plump the skin and hydrate it from the inside out. Surgical treatment of tear troughs is also possible and it depends mostly on the use of fat grafts or implants. 

How can I improve the appearance of tear troughs?

  • There are a wide variety of options for you to choose from if you are looking to improve the appearance of your under-eye hollows. You can choose from multiple home remedies and if you are looking for a more permanent solution for your tear trough appearance, then you can browse through the injectables and the surgical solutions for tear troughs. 

Why do tear troughs form?

  • Tear troughs form when the line between the eyes and the nose gets deeper. The deepening of the line is mostly due to weight loss or aging, in which the tissue volume decreases. They can become further exaggerated by stress, lack of sleep, dehydration, smoking, and excess caffeine. If dark circles form, then the appearance of the tear troughs will worsen. 

Does drinking water help tear trough?

  • Hydration is key for good skin. While proper hydration can plump the area and rejuvenate the skin from the inside out, it is not a permanent solution for tear trough deformities. It is important to invest in a proper and lasting solution for tear trough deformities.  

Can retinol help tear troughs?

  • Retinol is a great anti-ageing agent and can help reduce the appearance of under-eye lines and wrinkles. However, the agent is not that helpful in reducing the appearance of tear trough deformities and would not be the best agent to opt for. As the issue with tear troughs is the loss of volume, it is important to increase the volume rather than apply anti-aging solutions. Injectables of hyaluronic acid that hydrate and plump the skin are a much better solution for tear troughs. 

How do you hide tear troughs?

  • Hiding tear troughs is not as easy as many makeup gurus will have us believe. In fact, it requires a lot of time and energy, along with several colour-correcting makeup products, to effectively hide tear troughs. It is usually recommended to invest this energy and money into injectables and fillers for a much more lasting solution for tear troughs. 

Does everyone have tear troughs?

  • Most people do have tear troughs but some of these people get tear troughs at birth due to genetics and others acquire them as they age or lose weight. But everyone in the world suffers from them.

Who is not suitable for tear trough filler?

  • There are many criteria that you have to meet to be eligible for tear trough fillers. They are easy to get however, if you do not meet all the criteria and still undergo the procedure, the results may be disastrous instead of aesthetically pleasing. If you have dark circles or extremely thin skin under the eyes, then a filler is not the right fit for you. You can speak to your surgeon or an aesthetician for better solutions for you.

Read More about Eye Procedures

Medical References about Tear Trough Deformity

About Mr Mark Gittos FRACS (Plast) – London Plastic Surgeons 

Practice locations in London & Essex, UK and Auckland, New Zealand.

Mr Mark Gittos offers high quality, natural-looking cosmetic surgery results and is highly experienced in BreastBody and Face Surgery having performed over 4000 Surgeries in the last 26 years. 

With world-wide expertise Mr Gittos is an expert in breast, face and body surgery for men & women. 

Mr Mark Gittos is a leading Specialist Plastic Surgeon and operates a practice in London UK and Auckland New Zealand. His practice focuses on both surgical and non-surgical procedures, each designed to help restore, improve or change a physical characteristic or problem. The first step in every case is to talk through your personal requirements and explore all the options, before deciding on the most effective solution.

Naturally, before any treatment is begun, we will explain clearly the advantages and risk factors; so that you have the information you need to make an informed decision that is best for you. Visit the practice to find out more.


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