Prominent Tear Trough: Tear Trough Deformity

The prominence of the tear trough and noticeable hollowing around the eyes become more frequent complaints as we age. As we grow older, the mid-face begins to sag downward, the fat pads around the eyes start to herniate, and the infraorbital rim, which is the bone of the eye socket, becomes more prominent. Known as the tear trough deformity, this condition initially begins in the inner one-third of the lower eyelid near the nose and, with aging, progresses toward the mid-face and the outer parts of the eye area. Does an irregular lifestyle contribute to this appearance? Smoking and lack of sleep can accelerate the development of this condition at a younger age. Initially, it is noticeable in the inner part of the lower eyelid without significant signs of aging in either the upper or lower eyelids. Over time, with the sagging of the mid-face, the transition from the eyelid to the mid-face becomes more pronounced, and signs of aging begin to appear in both the upper and lower eyelids.

Patients with mild to moderate tear trough deformities who do not have significant wrinkles in the lower eyelid and maintain good skin quality can be treated with hyaluronic acid fillers. The effect of this treatment typically lasts 9-12 months.

For patients with under-eye fat bags, restoring the herniated fat to its original position is possible with lower eyelid surgery. Through an incision made just beneath the eyelashes, the herniated fat is repositioned, and any excess skin or wrinkles are addressed. Excessive removal of herniated fat in the lower eyelid, especially in younger patients, is not recommended. Additionally, during the procedure, fat grafts can be placed in the deeply hollow tear trough area.

In cases where mid-face sagging accompanies the condition, a mid-face lift should be combined with lower eyelid surgery. This approach corrects the sagging mid-face and restores the harmony between the cheek and eyelid.

Fat injection is an essential adjunct to all my facial surgical applications. Properly refined microfat grafts are particularly helpful in camouflaging the transition between the cheek and eyelid. However, it is crucial to avoid overfilling this area. Overfilling the lower eyelid can create the appearance that the cheek starts just beneath the eyelashes. Instead, repeating fat injections in a second or third session is a more logical approach.

Dark circles around the eyes do not completely disappear after either surgical or non-surgical treatments. The goal of these treatments is to correct the volume deficit and improve the contours. Although pigmentation or color changes may slightly lighten with these treatments, complete resolution is not achievable.