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Dr. Zoumalan's Blog - News and Updates

Using fillers to correct lower lid tear trough hollows or “lower lid bags”

Posted On 10/22/2013 by Dr. Christopher Zoumalan

Tear trough deformity is seen in people of all ages.  They can be seen forming in as early as patients in their 20s and upwards. With age, the lower eyelid “trough” or hollow tends to become deeper and people commonly complain of a tired look.  

Patients commonly describe these hollows as “eyelid bags, puffy eyes, and eye bags.” Interestingly enough, until recently, surgery used to be the only method for correcting tear trough deformity. As we now understand eyelid anatomy and the aging process better, we realize that the tear trough deformity mainly occurs due to a loss of volume in the midface which results in a hollowed-out appearance of the lower lid.  In order to best treat this volume loss and the tear trough deformity, Dr. Zoumalan uses advanced techniques with or without combination of surgery to rejuvenate this area of the face and to restore a more youthful, natural looking appearance. When performed in the office without surgery, Dr. Zoumalan uses hyaluronic acid filler injections (ie Juvederm and Restylane) to volumize the tear trough and the midface area.  

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Picture above. The area of the tear trough deformity is located above the black arrow. It results in a shadow effect which actually worsens the appearance of the hollowing.

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Pre-injection photo above. In order to address this deformity, in office hyaluronic acid fillers were injected using a micro-canula technique. Note the hollowing (tear trough deformity) with some early los of volume in her midface.

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Photo above: After filler treatment to the eyelid and midface. This photo was taken several weeks after the procedure. The procedure took approximately 45 minutes and was all done in the office using only local anesthesia with no sedation. The patient went home and had little swelling and minimal bruising.

The tear trough deformity (orbital rim hollowing) has been corrected and midface volume has also been naturally augmented. This particular patient had hyaluronic acid (HA) filler injections consisting of Restylane and Juvederm. Note that this patient did not undergo any sort of eyelid surgery.

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