How Are Under-Eye Bags, Dark Circles and Tear Troughs Treated?

Let's talk about a complex issue that's super important. Tear trough injections, right? The tear troughs, the dreaded tear troughs. What are they?

What should you do about it? How do you treat it? Dark circles, etc. So the way I like to look at it is multifactorial.

Sometimes the tear trough is a pseudo tear trough. If the fat bags under the eyes are large enough, they kind of bulge out and then they create a little shadow under them. In that case, you got to do a blepharoplasty, you got to go inside the eyelids, tease out this fat pad and basically flatten out and smooth it out. But oftentimes an actual tear trough is also present.

Even if the fat pads are protruding, there is actual trough or hollowness below it. So you may have heard of fat transposition where instead of removing the fat bags above it, we kind of transpose it and tuck it under. That gained lots of popularity 10-15 years ago. Still, there are some people that do it.

It's more technically challenging. The question is, does it stay there? What do you have to do? The dissection is much more involved.

So most plastic surgeons will do the more atraumatic way, remove the fat pads and then use fat to inject this area. Why? Because we are going to have to inject this area anyway. Most people that need tear trough volume also need a little bit of volume to the mid face.

So we're going to harvest some fat from somewhere on the body and inject these areas. So why not also inject the tear troughs instead of doing more drastic fat transposition? So those are the treatments. Now, can you just fill in the mid face and kind of plump it up?

Yes, because if you plump up the mid face, you basically shorten the length of the lower eyelid, the distance from the eyelash down to the orbital rim and you actually rejuvenate that area. This could easily be done with fillers. I know there's a lot of bad rap these days about fillers. Nonsense.

Fillers are perfectly fine. I do it all the time. You got to do the right technique. You cannot use cannulas.

You should not put it into the cheek soft tissue volume. You have to go straight down to the bone and teach this all the time. And this will be a beautiful thing you can do perfectly fine. Almost no risks.

It's an amazing immediate gratification. But if you want something more long term, you can do fat injection. So when we talk, we talk about lower eyelid blepharoplasty. We talk about fat injections to the lower eyelid tear troughs.

We talk about fat injections to the mid face or fillers in that area. And ultimately resurfacing by tightening the skin and doing a laser resurfacing that also improves that. So whenever you come in for the consult, we'll talk about all of that.