Tear Trough Rejuvenation (Under Eye Facial Filler)

The “Tear Trough” is the name that is given to the groove or hollow area that starts at the inner corner of your lower eyelid, and extends down and out into the cheek. The tear trough represents the area in the middle corner of your lower eyelid that sits directly over the rim of the bone of your eye socket. In all patients at any age, the skin of the lower eyelid is the thinnest skin in the body, much thinner than the cheek skin that is located just below this rim of bone. Normally, there is much less fat in the eyelid skin, and this already thin skin can become even thinner over time. This process can make the tear trough depression stand out more by creating a shadowing effect. Although it is not the only cause, this can be one of the main reasons why some people complain about the appearance of “dark circles” under the eyes.

The appearance of a tear trough is not necessarily a sign of aging. For many people, the normal anatomy and shape of the face can make this groove appear evident even in childhood. Over time, patients who have such facial shapes may be bothered by the tear trough area standing out more, while others may not notice this area troubling them for many years.

The reasons why the tear trough hollow can become more apparent over time include:

  • Normal loss of thickness of the eyelid skin with age
  • Normal loss of volume and support for the cheek, causing the cheek to sag and the underlying rim of bone to become more visible
  • The lower eyelid fat bags have become larger over time, making the hollow of the tear trough appear to stand out more (think about how much deeper a valley would look if you were standing on a mountain next to it)

For some people who have deeper set eyes, loss of volume in the lower eyelid skin over time can cause additional shadowing over the lower rim of bone of the eye socket. Along with the tear trough area, sometimes, this shadowing can also extend over the full length of bone in the lower eyelid and into the outer corner of the eye socket as well. In these cases, the lower eyelid skin may start to appear to have more wrinkles. Additionally, loss of volume in the lower eyelids can significantly affect the light-reflectance patterns of the face, and this can often make the eyes appear somewhat darker by creating some undesirable shadows in the surrounding areas.

Brightness in the area around the eyes conveys a youthful, energetic, well-rested, and healthy appearance. Conversely, areas of darkness, hollowing, or shadowing in the area around the eyes might falsely make you appear to be tired, weathered, or older than your actual age. A loss of volume in the lower eyelid skin can be due to a combination of factors including: genetics, facial shape, weight, diet, alcohol intake, hormone changes, medical conditions, medications, allergies, environmental stresses such as sun exposure and smoking, and sleep patterns. Over time, these changes will shift the primary focal point of the face away from the eyes (the most desirable location), and usually to a lower position, causing people to start to notice more heaviness in areas of the lower face, such as around the mouth, in the nasolabial folds, and near the jawline.

Tear Trough Rejuvenation is an excellent way to add more natural, youthful lower eyelid volume without the more extensive downtime from surgery. Dr. Lewen’s primary goal with Tear Trough Rejuvenation is to re-establish youthful eyelid contours, balance, and harmony. By restoring natural and adequate volume to the tear trough, this will reestablish normal light-reflectance patterns to the area around the eyes, and will often cause the eyes to appear brighter, as well as lessening some of the shadowing effects below the eyes. In many cases, Tear Trough Rejuvenation may be able to give you a significant improvement in the appearance of your lower eyelid hollows, bags, or wrinkles without the downtime or commitment of lower eyelid surgery.

Dr. Lewen typically performs Tear Trough Rejuvenation as an in-office procedure with most patients experiencing minimal or no discomfort. Some degree of bruising and swelling can be expected after the procedure, but this will vary based on each individual patient.

Tear Trough Rejuvenation is a procedure that is frequently performed in combination with other, minimally-invasive cosmetic procedures, such as Liquid Cheek Augmentation, Temple Augmentation, and CO2 Laser Resurfacing. This procedure may also sometimes be combined with other cosmetic surgical procedures as well. The relationship between the lower eyelids and the midface, along with the smoothness of transition between these two areas of the face, is integral for the best possible cosmetic rejuvenation with natural-appearing results. For this reason, the ideal rejuvenation of the lower eyelids for many patients may necessitate some degree of volume replacement in the lower eyelids, as well as in the midface with Facial Filler injections, such as Liquid Cheek Augmentation, to create a smoother transition between the lower eyelids and the midface tissues.

Dr. Lewen’s meticulous technique for Tear Trough Rejuvenation not only addresses the cosmetic portion of the lower eyelid area but also serves to improve lower lid support. In many cases, proper volume replacement in the lower eyelids can reduce the amount of lower eyelid skin that may initially appear to be in excess as this area becomes “re-inflated.”

How is Tear Trough Rejuvenation performed?

Tear Trough Rejuvenation procedures involve a very delicate and sensitive area of the face. With his advanced sub-specialty training and background in OculoFacial Plastic Surgery, Dr. Lewen maintains a detailed appreciation for the complex anatomy of the lower eyelids, and other such areas around the eyes and face. Due to the sensitive nature of this area, these injections should be performed by a qualified, board-certified surgeon. Dr. Lewen uses a series of advanced injection techniques to perform this minimally-invasive procedure in the office. His sub-specialty training, keen aesthetic eye, and unique attention to detail will ensure that you will maintain the appropriate shape and contour of your lower eyelids to give you the best and most natural enhancement. Depending on your individual anatomy, Dr. Lewen may perform Tear Trough Rejuvenation with the use of a blunt-tipped cannula. If appropriate for the shape of your face, this advanced injection technique also has the added benefits of improved patient comfort and less bruising when compared to facial filler injections that are performed with a needle.

During your consultation, Dr. Lewen will take extra care to listen to your specific concerns and cosmetic desires. After a brief examination, Dr. Lewen will then share his recommendations for your best treatment plan. At times, Dr. Lewen may recommend a more conservative, stepwise approach to give you the most natural-appearing result. Before your treatment, a member of the office staff will apply some numbing cream to the lower eyelid areas that are being treated. Afterwards, these eyelid areas will be carefully prepped to ensure that all makeup and oils are removed from the skin, and that the skin surface is sterile before starting your Tear Trough Rejuvenation procedure.

For this area of the face, Dr. Lewen only utilizes very specific facial filler products that have been well-demonstrated scientifically to have the most beneficial properties when injected into the lower eyelid areas. Many of these products now come pre-mixed with numbing medicine, and in some cases, Dr. Lewen will add some additional numbing medicine for optimum patient comfort. After the injections are performed, Dr. Lewen will carefully mold the products to ensure smoothness of contour, and to minimize the risk for any irregularities. Ice is also used as an additional form of anesthesia for certain areas that can be more sensitive to provide the easiest and most comfortable experience during injections.

After your procedure is completed, Dr. Lewen’s staff will provide you with ice packs to apply to the treated lower eyelid areas, and you will be given a detailed post-procedure instruction sheet.

Does it hurt?

Pain tolerance amongst patients can vary considerably. However, Dr. Lewen and his staff routinely show careful consideration to individual patient sensitivities in this delicate area of the face. We are committed to helping ensure that your Tear Trough Rejuvenation procedure is as painless and easy as possible. By utilizing topical numbing cream before your procedure, along with numbing medicine mixed in the injection product, Dr. Lewen is completely dedicated to minimizing your discomfort during this procedure. You can rest assured that he will communicate with you throughout the procedure so that you are aware of exactly what he is doing, and the office staff will also be present to help ease you through the experience.
How often will I need this treatment?

Individual patient anatomy in this area of the face can vary considerably. Depending upon the severity of your volume deficiency or creasing and the amount of product required to correct this area, most patients will find that the results from Tear Trough Rejuvenation can last for over a year. It is important to remember that every person metabolizes facial filler product somewhat differently, and therefore, individual results may last for variable amounts of time. Dr. Lewen usually recommends that his patients schedule a follow-up appointment at about 6-9 months after Tear Trough Rejuvenation to evaluate the area and determine the best schedule for maintaining your results.

What is the downtime?

Every patient is somewhat different in terms of the healing time required after a Tear Trough Rejuvenation procedure. Procedures that require more product volume will typically have slightly more healing time required. Although Dr. Lewen utilizes advanced injection techniques to minimize bruising as much as possible, this can still occur with these injections, and you should also expect some degree of swelling in the treated area afterwards. Applying ice to the treated area immediately afterwards, and for the first 24-48 hours, will significantly reduce the risk of additional bruising and swelling in the area. Arnica, a homeopathic remedy, may also help to alleviate swelling and bruising somewhat faster. There is no downtime required after Tear Trough Rejuvenation, and you can resume normal exercise 24 hours after treatment.

Please Note: Due to the normal thin-skin nature of the lower eyelids, at times, this area of the face tends to show swelling as a result of fluid retention more than some other areas of the body. As such, in order to get the quickest and best results after this treatment, it is generally recommended to make sure that you try to do the simple things to limit general fluid retention immediately after having a Tear Trough Rejuvenation procedure performed. These steps include:

  • Using ice over the treated area for the first 24-48 hours
  • Making sure to drink enough water (at least 8 glasses of 8-ounces of water daily, if not more)
  • Trying to limit dietary sodium intake (this might not be the best time to go out for pizza or Chinese food)
  • Trying to limit alcohol intake (alcohol is a diuretic and can dehydrate you)
  • Using over the counter artificial tear drops to control any dry eye issues (even a little bit of dry eyes can cause more swelling in the sensitive eyelid skin)
  • Treating any environmental allergies that may be present (again, even a small amount of an allergy response to something in the environment can cause a little extra swelling in the delicate lower eyelids)

Even with the best care, sometimes, a little swelling in this area can be unavoidable after treatment. It is important to be patient, and to remember to allow your body the time it needs for the treatment to fully settle. Although many patients will see results immediately after treatment, you should expect your final results from Tear Trough Rejuvenation to settle in by about 1-2 weeks after your treatment.

If you have any additional questions or concerns about downtime following a Tear Trough Rejuvenation procedure, please contact one of Dr. Lewen’s Patient Coordinator’s to learn more about what can be down pre- and post-treatment to ensure that you have as little downtime as possible!