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Bryan G. Forley, M.D., F.A.C.S. plastic surgeon practicing in New York City - Slide 7

He is by far the best of the best and I would never go anywhere else.”

Stefani
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TEAR TROUGHS: THE REASON PEOPLE KEEP ASKING IF YOU ARE TIRED

The first signs of aging in the face often occur around the eyes and are typically described as baggy lower eyelids.  Multiple factors contribute to this appearance including a pattern of sun exposure, lack of sleep, alcohol use, poor diet, and stress.  Sometimes it’s simply unlucky anatomy that results in the eyes appearing hollow and prematurely aged even in your thirties.  This can lead to a weary appearance with prominent circles under the eyes known as “tear troughs”.  The tear trough disrupts the smooth transition from the lower eyelid to the cheek which we visually associate with a rested, more youthful look.   Replacing the lost volume under the eyelid masks the tear trough and produces a younger, refreshed appearance that, in many cases, can postpone the need for a more invasive surgical procedure.

Tear trough at lower eyelid/cheek junction
Tear trough at lower eyelid/cheek junction

Restylane® is an injectable dermal filler commonly used to restore volume in the tear trough.  It is composed of hyaluronic acid, which is naturally present in the skin, and has been proven to last up to 12 months in clinical studies.   During the treatment, small droplets of filler are injected deep along the tear trough and then gently massaged into place.   The most common side effects of the procedure are short term bruising and swelling.

Fat grafting is a minor surgical procedure, performed under local anesthesia that can also be used to achieve correction of the tear troughs.  Fat cells are obtained using liposuction from a donor site such as the hip or abdomen and specially processed to concentrate the cells prior to injection.  While fat grafting offers a long-lasting solution to volume loss and can last for years, there are some limitations to the procedure.  The injected fat has to develop a blood supply from the surrounding tissues for it to achieve long-term survival and may require additional treatments to achieve the desired correction.

Blending of lower eyelid/cheek junction after treatment
Blending of lower eyelid/cheek junction after treatment

These techniques and procedures apply to more than just the tear troughs.  Just as volume depletes from the under eye, it also diminishes and migrates in other areas of the face.  Dermal fillers and fat grafting can also be used to treat volume loss in the mid-face and cheeks to assist in restoring smooth contours and a youthful appearance.

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Written by Dr. Forley on April 17, 2011

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