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Learn About Tear Troughs & Causes of Under Eye Bags

The tear trough, also known as the nasojugal groove, is a small lesion of skin that runs from the inner eye to the outer corner. At times when a patient is seen with a baggy or puffy palpebromalar groove it create a division of skin between the lower eyelid and cheek. At our oculoplastic surgery practice, Dr. Christopher Zoumalan, MD FACS can treat patients for such conditions with tear trough fillers.

Both under-eye bags and tear trough deformities can result in a tired and aged appearance. They can often occur together and are both associated with either loss of fat or a gain in fat in certain areas around the eyelid structures.

Until recently, surgery used to be the only method for correcting tear trough deformity or under-eye bags, but Dr. Zoumalan uses advanced techniques and injection treatments — with or without surgery — to rejuvenate this area of the face and to restore a more youthful, natural-looking appearance.

What Causes Lower Eyelid Bags

There are various causes that result in changes to the lower lids with aging. Some people end up having dark circles and others end up having more prominent bags appear in their lower lids as they age. Under-eye bags occur with age as the naturally occurring fat pockets around the eyeball grow. With time, the fat under the eyeball tends to protrude or herniate through the thin eyelid skin.

Tear trough deformity is a problem that can be present in adults of all ages. I see them in patients as early as their 20s and also in mature adults, even up to their 70s and 80s. With age, the lower eyelid trough becomes deeper. People commonly complain of a tired look and note they have eyelid bags, puffy eyes, and under-eye bags.

Tear Trough Fillers for Lower Eyelid Bags

Facial fillers are the primary treatment for the lower eyelids, which can certainly help in improving the volume deficiency or deformity people get with aging and can reduce the amount of herniated fat visible to others. Fillers can also help improve the appearance of hyperpigmentation that is often present in such cases. Hyaluronic acids or fat grafting in this area is a prefered solution.

About the Procedure:

The procedure is performed in the office with the assistance of a topical anesthetic. It can take as little as 30 minutes if using hyaluronic acids (i.e., Restylane or Juvederm) and patients usually go home afterward without any problems.

Dr. Zoumalan has introduced the use of a blunt-tipped cannula for most of the facial filler injections, which allows him to reduce the incidence of bruising and discomfort by a significant percentage in my patients. The results are overwhelmingly incredible and the patients are extremely comfortable during the procedure with just the use of a topical anesthetic.

The blunt-tipped cannulas used for my facial filler injections are similar to the ones used in the operating room for my fat grafting procedure, which has made the transition to using the cannulas in the office readily available.

fillers
Actual patient of Dr. Zoumalan

Dark circles are present in both lower lids, right worse than left.

The patient shown above had dark circles that were present in both lower eyelids and the right eyelid was significantly worse than the left eyelid.

She received dermal fillers to the eyelid and cheek areas to build up the volume she had lost due to aging. The green dots in the third image indicate the ONLY location that the skin was pierced to perform the procedure using a blunt-tipped cannula.

This helps reduce multiple injection sites, minimize bruising, discomfort, and swelling. The blue dots indicate where Restylane was injected (over the orbital rim) and the red dots indicate where Juvederm was injected (over the midface and cheek area).

Make Dr. Zoumalan Your Choice for Tear Trough Fillers

Oculoplastic surgery is a passion of ours and we are pleased to restore the youthful look of a patient’s face without the use of invasive surgery. If you find that your eyelids are lacking ideal volume and in need of tear trough correction then fill out our consultation form to get in touch with Dr. Zoumalan. Tear trough fillers have been performed routinely at our practice to provide natural and exceptional results.

Common Question and Answers
  • image

    Preoperative diagnosis: Lower eyelid bags (ie lower eyelid fat prolapse, right worse than left). Loss of midface volume.

    Procedure performed: Hyaluronic acid (HA) fillers to the orbital rim (tear trough) and midface. In this patient, Restylane was used below the eyelid bags. Juvederm was used to augment the midface and to restore the volume that had been lost. Pre and post photos are shown above.

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    Preoperative diagnosis: Facial wrinkles, lower lid rhytids (wrinkles) and tear trough hollows (ie dark circles).

    Procedure performed: Botox to forehead and crows feet, hyaluronic acid (HA) fillers to the tear trough area and midface, 30% trichloroacetic acid (TCA) chemical peel to lower lids.

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    Preoperative diagnosis: Tear trough deformity (orbital rim hollowing) and loss of midface volume. The dark lower lid circles are a result of a loss of volume in the tear trough area and a result of some “extra” fat that has herniated.

    Procedure performed: Hyaluronic acid (HA) fillers to orbital rim (tear trough) and midface.

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    Preoperative diagnosis: Tear trough deformity (orbital rim hollowying) and loss of midface volume. The patient has visible eye bags, right worse than left. The dark shadows are a result of a loss of volume in the tear trough and also a result of “extra” fat that has herniated.

    Procedure performed: Hyaluronic acid (HA) fillers to orbital rim (tear trough) and midface.

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    Preoperative diagnosis: Tear trough deformity (orbital rim hollowying) and loss of midface volume. The dark shadows/circles are a result of a loss of volume in the tear trough and not a result of “extra” fat that has herniated. This image is snapshot image taken from our 3D imaging system.

    Procedure performed: Hyaluronic acid (HA) fillers to orbital rim (tear trough) and midface. In this patient, Restylane was used around the tear trough and orbital rim. Juvederm was used to augment the midface and to restore the volume that had been lost. Pre and post photos are shown above.

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    Preoperative diagnosis: Lower lid fat prolapse (ie bags under eyes). History of prior blepharoplasty with residual fat pads. Loss of midface volume.

    Procedure performed: Hyaluronic acid (HA) fillers to orbital rim (tear trough) and midface. In this patient, Restylane was used around the tear trough and orbital rim. Juvederm was used to augment the midface and to restore the volume that had been lost. Pre and post photos are shown above.

  • image

    Preoperative diagnosis: Lower lid fat prolapse (ie bags under eyes) and loss of midface volume.

    Procedure performed: Hyaluronic acid (HA) fillers to orbital rim (tear trough) and midface. In this patient, Restylane was used around the tear trough and orbital rim. Juvederm was used to augment the midface and to restore the volume that had been lost. Pre and post photos are shown above.