Tear trough implants are used in a procedure done to correct a condition known as Tear Trough Deformity and/or to eliminate dark circles under the eyes. In a majority of older patients, the protruding eyelid skin and fat of their lower eyelids cast shadows that accentuate dark circles under their eyes.
Tear Trough Deformity is a depression of the medial lower eyelid where it meets the cheek. With aging the dark circle under the eye becomes deeper, longer and runs down and out into the cheek. It is called the Tear Trough Deformity because tears run into the dark circle and out to the side of the cheek, instead of rolling straight down the cheek as they do when children cry.
For some people it is a small groove and for others it is extremely deep. The condition tends to worsen with age and is often hereditary. For many people the dark circles under the eyes associated with Tear Trough Deformity is their major complaint.
Tear trough implants are made of silicone, which is a soft, rubber-like material. The implant is inserted through a small incision, then placed over the bone mass under the eyelid for a fuller, more youthful appearance.
Oculoplastic surgeon Dr. Amiya Prasad uses a transconjunctival method of surgically inserting implants through a small laser incision in the inside of the eyelid. This advanced surgical technique leaves no visible signs of surgery or scars since no incision is made on the outside of the eyelid. Transconjunctival tear trough implant surgery has a faster post-operative healing time than other less effective surgical techniques due the surgery done with local anesthesia with LITE™ IV sedation rather than general anesthesia. Tear trough implant surgery does not change the shape of the lower eyelid.
Should I get tear trough implants, fat grafting, or filler?
Hollowness under the eyes is a common problem that can even appear in young people.
People suffering from under eye hollowing often seek a permanent solution in the form
of implants, or fat grafting.
I’ll discuss how I counsel my patients about the options for under eye hollowing in my
I’m Dr Amiya Prasad. I’m a Board Certified Cosmetic Surgeon and Fellowship Trained Oculofacial Plastic & Reconstructive Surgeon. I’ve been in practice in Manhattan and Long Island for over 20 years.
For patients who’ve come to me for under eye hollowing, I have performed procedures such as the placement of tear trough implants, as well as fat grafting.
I’m also well known for my work with cosmetic fillers throughout the face, including the under eye area to treat hollowing and slight eye bags.
It’s a common request from patients is to have a permanent solution for many things including under eye hollowness.
Earlier in my career, long before the introduction of injectable fillers, I would place implants called tear trough implants.
Tear trough implants are made of soft silicone, and are specifically designed for the under eye area.
When I perform tear trough implant surgery, I insert them through a transconjunctival approach, meaning from the inside of the eyelids without any external or visible incision.
We understand very well how facial aging is proportionately greater at the bone level, which means bone loss will progress regardless of the presence of an implant.
This means that with normal aging, the implant may become more visible and additional volume
would be needed.
Another so-called “permanent” option, which is offered is fat grafting.
Simply stated, fat does not provide uniform and predictable improvement and is likely to not survive or worse become lumpy and irregular.
Patients come to us from around the world distressed about the results of fat grafting under the eyes with the desire to have them removed.
Technically, the procedures for removal and grafted fat under the eyes is complex and often requires multiple sessions..
Some doctors offer permanent or semi-permanent fillers.
In my opinion, if given a choice, I would prefer to use a filler that can be easily removed.
If any of these semi-permanent and permanent fillers were to be seeded with bacteria resulting in biofilm or frank infection, management can be very difficult.
Once again, placing something permanent in the soft tissue can be cosmetically problematic as aging and volume loss naturally progresses.
Like fat grafting, removing permanent or semi-permanent fillers is an extremely complicated process, and not all the material will be removed.
At this time, my preferred treatment for under eye hollowing is with a soft hyaluronic acid filler such as Restylane or Juvederm.
I place these fillers in my office exam room with minimal trauma using blunt cannulas.
This approach allows me to improve under eye hollows with precision and usually without bruising.
Soft tissue fillers move well with facial expressions, and they have no rigid edges which are more often associated with implants.
Hyaluronic acid that makes up fillers like Restylane and Juvederm occurs naturally in the body, so these types of filler are well tolerated and safely metabolized by the body.
I find that a filler is more customizable than an implant.
Fat graft which can lose 30-70% of their mass during the healing process cannot be customized in the way fillers can.
Further, I appreciate the security of being able to dissolve a hyaluronic acid filler within minutes of placement of an enzyme called hyaluronidase.
Just as the face changes with aging as well as other factors such as weight gain and weight loss, filler placement can be customized to these changes.
Hollow eyes are often associated with crepey and sun damaged skin.
I often use PRP or platelet rich plasma to improve the quality of the delicate under eye skin.
PRP or platelet rich plasma is a concentration of the wound healing factors in your blood which stimulates collagen and blood supply to the skin.
There is also a medically well established synergy between hyaluronic acid and PRP.
Placement of filler for the tear trough is quick, however I explain to my patients that it takes about 2 weeks for the material to settle.
At the 2 week point, I look at the results and compare to the appearance before the procedure and make adjustments as is appropriate.
When considering under eye hollowing treatment, it’s important to understand there are no permanent treatments as the body itself is not permanent.
In particular, the bone and soft tissue.
The eye area is delicate, and eyelid skin is the thinnest skin in the body.
In comparing the options of tear trough implant, fat grafting and hyaluronic acid filler, my preferred approach is the use of hyaluronic acid filler.
My ability to accurately contour with minimal trauma, with convenience as well as ease of removal makes hyaluronic acid filler the best choice for my patients for tear trough and hollow under eyes.