The tear trough is the hollowing in the area under the eyes, specifically between the lower eyelid and the top of the cheek. Some people are born with a more prominent tear trough (genetics), while others develop deeper tear troughs due to the aging process, sun exposure and stress. Hollowing in this area can create an overall tired, aged look around the eyes.
There are key changes in the undereye area as we age that contribute to the hollowing, puffiness, and hyperpigmentation. As we age, the skin becomes thinner. Soft tissue changes in the form of losing the fat just under the skin result in the underlying deep fat pad becoming more visible.
Furthermore, bony changes around the eye socket and the anterior cheek contribute to hollowing and visible circles. Volume loss in either the skin or soft tissue can contribute to darker pigmentation as well. Restoring volume to the undereye area as well as the anterior (midface) cheek can create a more refreshed, youthful look.
Three treatments to address the undereye area are: injecting dermal filler thus restoring lost volume; injecting PRP/PRF to increase collagen and elastin production; and/or filling the midface/anterior cheek restoring volume loss giving support to the tear trough area.
With dermal filler, your undereye area will look fuller and more refreshed directly after the treatment. However, best results are 2-4 weeks after treatment as the filler settles and pulls in a small amount of water. Because this area can be sensitive to overfilling, “under correction” and waiting 2-4 weeks before assessing if more filler is needed is recommended. Therefore, a second treatment may be necessary to achieve the desired result. Often, “full correction” meaning you cannot detect any groove, line, hollow, bag, or hyperpigmentation is unachievable due to a variety of factors. The goal is to soften the appearance of the aforementioned thus making them less prominent. Restoring the undereye area can be quite challenging because each person’s tear trough presents differently. Not everyone is a good candidate for dermal fillers.
Individuals with herniated fat pads or excessive skin, for example, will more than likely not get the desired outcome and surgical intervention may be necessary. Occasionally, individuals may not respond to dermal filler in a typical fashion resulting in increased puffiness due to fluid retention. You may also experience intermittent swelling and tenderness in this area when contracting a cold/flu or with severe seasonal allergies. An in-depth consultation is required before booking this treatment.
Injections with PRP/PRF can be great choice for those who are interested in a more natural approach or those who are not an ideal candidate for dermal filler. PRP/PRF contains your own growth factors and stem cells which stimulate collagen and elastin production. This helps to tighten the skin around the eyes lessening the appearance of fine lines and wrinkles. While PRP/PRF does increase volume under the eyes, it is best used to increase smoothness and improve the appearance of the skin. If treating hollowness is your main concern, undereye filler will often give a more dramatic result. A series of treatments are recommended for best results.
Volume loss in the midface can be a significant factor in the appearance of hollowing in the area called the “lid-cheek junction.” By adding filler to the midface, you restore the continuity and smooth contour from the cheekbone to the undereye referred to as the ogee curve (another post detailing this coming soon…). Replacing volume loss in the midface and lid-cheek junction can sometimes correct the tear trough defect without filling the tear trough itself.
In addition to any of the treatments highlighted above, microneedling and medical-grade skincare can boost results as this helps to address the surface changes in the skin resulting in plumper, smoother skin.