A rarely discussed area of the face is the
tear trough (or
nasojugal groove). The tear trough is the groove located where the lower eyelid meets the cheek. Some people have just a hint of a groove and others have an extremely deep groove. It is often hereditary and typically gets worse with age. People often complain of "dark circles" when referring to the tear trough deformity.
There are various treatment options for the tear trough. One option is fat grafting. Fat is taken from another part of the body (abdomen, inner thigh, knee), placed in a syringe and carefully injected into the tear trough. Because the lower eyelid skin is the thinnest skin on the body, there is a risk if the fat lumping and becoming visible. Some of the fat is absorbed by the body, although a certain amount remains as living, viable fat cells.
Another option is a silicone implant. This implant, made of solid silicone rubber, is not commonly used, but it is an option for some people. Again, because of the thinness of the skin in this region, the implant can be visible.
There are a few options that I prefer, some surgical and one non-surgical:
1. Non-surgical -- I have had tremendous success with
Restylane injections to the tear trough. Surprisingly, these injections are virtually painless and require just a topical anesthetic cream. The Restylane is placed deep to the skin just above the orbital bone, to minimize the risk of visibility or lumps. The best results are seen in patients with relatively thick skin, since the risk of lumps is minimized in these patients. Older patients with thinner skin are best treated with a thinner soft tissue filler, such as Cosmoderm. Bruising is fairly common with this procedure, but it can be easily covered with makeup. A recent study showed that bruising occurred in 50% of patients and minor irrecularities occured in 20% of patients. The Restylane typically lasts more than six months in the tear trough.
2. Surgical -- There are two good surgical options for the tear trough:
(a)
Fat transpostion. This is probably my favorite surgical option that addresses only the tear trough. In this procedure, fat that is already present in the lower eyelids (the lower eyelid 'bags") is slid down (or "transposed") into the tear trough. Because this fat is living fat (it is left attached to its blood supply), it does not slowly go away like injected fat (see above). The incision can be either inside the lower lid or on the skin just below the lashes.
(b)
Cheek lift. This is another great option to soften the tear trough. In addition to softening the tear trough, it also results in a more youthful appearance to the face in general, since it involves lifting the cheek up to cover the tear trough. The cheeks fall with age, so the cheek lift simply puts the cheeks back to where they once were. There are various ways to do this. One involves an incision in the hairline near the temple. Another involves an incision in the lower eyelid.
