Home LOOK GOOD Tear Troughs: Causes and Treatment Options

Tear Troughs: Causes and Treatment Options

by Michael Healy
tear troughs

One of the most common facial features that reveal the passage of time is the development of something known as tear troughs. Tear troughs are depressions that form beneath the eyes and cast a shadow that can make an individual appear tired, aged, or even unhealthy. 

While the formation of tear troughs is usually not a significant health issue, their initial appearance can be unsettling. Considering this, it’s important to understand the causes of tear troughs, how they affect an individual’s appearance and self-esteem, and various treatment options that are available to address this concern.

The anatomy of tear troughs

Tear troughs are located in the delicate area directly beneath the eyes. These depressions extend from the inner corner of the eye and follow the curvature of the lower eyelid towards the cheek. They are primarily caused by the interaction of a number of different anatomical structures, which include the following:

Suborbicularis oculi fat (SOOF)
The SOOF is a pad of fat that cushions the naturally bony rim right below the eye socket. Over time, this fat pad can start to shrink and sag, contributing to the formation of tear troughs.

Orbicularis oculi muscle
This muscle surrounds the eye and is responsible for a number of different facial expressions, including smiling, frowning, and squinting. As individuals age, the orbicularis oculi muscle can weaken and begin to lose its ability to support the tissues around the eyes.

Ligaments and connective tissue
Various ligaments and connective tissues around the eyes hold the skin and underlying structures in place. Over time, these structures may start to lose their elasticity and resilience, leading to sagging and the formation of depressions.

The skin located in the area directly under the eyes is some of the thinnest on the body, making it susceptible to showing signs of aging and fatigue more easily. It’s also more prone to pigmentation irregularities and the development of fine lines and wrinkles, especially with age.

Blood vessels and lymphatics
The under-eye area has a network of blood vessels and lymphatic vessels. Poor circulation and lymphatic drainage can lead to puffiness and dark circles, further contributing to the appearance of tear troughs.

What causes tear troughs?

Several factors contribute to the development of tear troughs, and most can be categorized as internal and external factors.

Intrinsic causes of tear troughs

The natural aging process leads to the overall loss of skin elasticity. This decrease of collagen and elastin, coupled with the sagging of facial fat pads, contributes to the formation of tear troughs under the eye.

A person’s genetic makeup can predispose them to certain facial features, including the appearance of tear troughs. Some individuals are more prone to developing these depressions at various ages, primarily due to their family genetics and family history.

Extrinsic factors of tear troughs

Sun exposure
Prolonged and unprotected exposure to ultraviolet (UV) radiation can accelerate the breakdown of collagen and elastin in the skin, hastening the development of tear troughs.

Smoking is known to accelerate the aging process and negatively affect skin health. Smoking has also been shown to decrease circulation throughout the body, leading to premature wrinkling and the development of tear troughs.

Poor skin care habits
Neglecting proper skin care, including moisturization and the use of sunscreen, can contribute to skin damage and lead to the formation of tear troughs.

Chronic allergies can cause inflammation and fluid retention in and around the under-eye area, leading to puffiness and the appearance of tear troughs.

Hydration and other lifestyle factors
Dehydration and certain lifestyle factors, such as excessive alcohol consumption and lack of consistent sleep, can exacerbate the appearance of tear troughs. Inadequate hydration can cause the skin located under the eyes to look dull and dehydrated.

Evaluating the impact of tear troughs

Tear troughs can have a significant impact on an individual’s appearance and self-esteem. They can give the impression of fatigue, chronic sadness, or advanced age, even when a person is well-rested and in good health. The aesthetic and psychological consequences of tear troughs can include:

Aged appearance
Tear troughs are often associated with the natural aging process. As they deepen, they can create the illusion of advanced age, which often leads to feelings of self-consciousness and reduced self-esteem.

Tired and unhealthy appearance
The shadow created by tear troughs can make an individual appear perpetually tired or unwell, even if they are well-rested and in good health.

Self-esteem and confidence
The visible signs of aging, such as tear troughs, can erode an individual’s self-esteem and self-confidence – especially when they occur in younger people. 

While it’s nearly impossible to turn back the hands of time, many people seek treatment to prevent the appearance of advanced aging, including reversing the appearance of tear troughs.

Treatment options for tear troughs

Fortunately, several treatment options are available to address tear troughs and rejuvenate the under-eye area. These treatments can be broadly categorized into non-surgical and surgical approaches, each with its own advantages and considerations.

Non-surgical treatments for tear troughs

Topical skincare products and dermal fillers

Applying high-quality eye creams and serums containing ingredients like hyaluronic acid, peptides, retinol, and antioxidants can help improve the appearance of the skin around the eyes. These products can hydrate the skin, stimulate collagen production, and reduce the appearance of fine lines, wrinkles, and tear troughs.

One of the most popular non-surgical options for treating tear troughs is the use of dermal fillers. Hyaluronic acid-based fillers are commonly used to add volume and smooth out the under-eye area. These fillers work by filling in the hollows and creating a more youthful and refreshed look. 

While the results created by using skincare products and dermal fillers are temporary, they are minimally invasive and typically require little to no downtime.

Platelet-rich plasma (PRP) therapy

PRP is a type of regenerative therapy that involves extracting a small amount of the patient’s blood, processing it to concentrate the platelets, and then injecting the PRP into the under-eye area. This treatment contains growth factors that can stimulate collagen production, improving skin quality and reducing the appearance of tear troughs.

PRP therapy utilizes the body’s natural healing properties and has been shown to have a minimal risk of allergic reactions or other adverse effects. More expensive than other non-surgical treatments, PRP therapy typically requires multiple treatment sessions before results will become apparent.

Chemical peels and laser resurfacing 

Chemical peels, such as glycolic acid or TCA peels, can improve skin texture and tone. They are also commonly used to help reduce the appearance of dark circles and fine lines, helping to make tear troughs less prominent.

Laser treatments, such as fractional laser therapy, can help improve skin texture and stimulate collagen production. This can also lead to a reduction in the appearance of tear troughs. 

Like PRP therapy, chemical peels, and laser resurfacing typically require multiple sessions in order to achieve optimal results.

Surgical procedures for tear troughs

In some cases, non-invasive treatments may not provide the desired results or individuals may have more severe tear troughs that require more intensive treatment. In these instances, surgical options can be considered and include:

Lower eyelid Surgery

Lower eyelid surgery, or lower blepharoplasty, is a surgical procedure that involves removing excess skin and fat from the under-eye area and tightening the surrounding tissues. This procedure can help eliminate tear troughs and create a more youthful and refreshed appearance. Lower blepharoplasty is a more invasive procedure and requires a longer recovery period compared to non-surgical options.

Fat transfer

Fat transfer, also known as fat grafting or autologous fat transfer, involves taking fat from one area of the body (usually through liposuction) and injecting it into the under-eye area to restore lost volume and fill in hollows. This procedure typically provides a more natural and long-lasting solution to tear troughs.

Combining surgical and non-surgical treatments

In many cases, a combination of non-invasive and surgical treatments may be recommended to achieve the best results. For example, a surgeon may perform lower blepharoplasty to address excess skin and fat, followed by the use of dermal fillers to further enhance the contour of the under-eye area.

Selecting the right tear trough treatment option

The choice between non-surgical and surgical treatments for tear troughs should only be made after a thorough evaluation by a qualified practitioner or surgeon. Several factors should be considered when making this decision. Some of these factors include:

Severity of tear troughs
The extent of tear troughs, as well as the presence of other concerns in the under-eye area (such as loose skin), will influence the choice of treatment options. In general, non-surgical options are better suited for mild to moderate tear troughs, while surgical procedures may be more appropriate for severe cases.

Desired or expected results
Before undergoing any type of treatment, patients should have a clear understanding of their aesthetic goals and expectations. Non-surgical treatments often provide more subtle and temporary results, whereas surgical procedures tend to offer more dramatic and lasting outcomes.

Downtime and recovery
Non-surgical treatments typically involve minimal downtime, while surgical procedures may require a longer recovery period. Patients should consider their availability and willingness to undergo downtime when choosing a treatment.

The cost associated with a tear trough procedure is an important factor to consider. Non-surgical treatments are often more cost-effective initially but may require maintenance and repeat procedures over time. Surgical procedures may have a higher upfront cost but provide long-lasting results.

Patient health and age
The patient’s overall health and age can often impact the choice of treatment. Older individuals or those with specific medical conditions may not be suitable candidates for surgery, making non-surgical options a safer choice.

Risks associated with tear trough treatments

Regardless of the tear trough treatment option you might select, there are some potential risks and considerations to be aware of, including:

Allergic reactions
While dermal fillers are generally well-tolerated, allergic reactions or adverse events can occur. Patients should discuss their medical history and any known allergies with their practitioner before any procedure.

Over-correction or under-correction
Achieving the desired results with non-surgical dermal fillers can be a delicate balance. Over-correction can lead to an unnatural appearance, while under-correction may not provide the desired improvement.

Surgical procedures carry a risk of infection. Like any invasive medical procedure, the risk of infection can be minimized through proper surgical techniques and post-operative care.

Lower blepharoplasty involves incisions that may result in visible scars. While surgeons make every effort to place incisions inconspicuously, there is always the risk of permanent visible scars.

Uneven results
Fat grafting can lead to uneven results if the transferred fat does not survive uniformly. This may require future touch-up procedures to correct any visible imbalance.

Skill of the practitioner or surgeon|
The experience and expertise of the practitioner or surgeon performing the procedure are crucial for achieving optimal results and minimizing risks. Always do your research and only select the most qualified professional.

A final thought on tear troughs

Ultimately, the goal of tear trough treatment is not only to address the physical signs of aging but also to help individuals regain their confidence and achieve a more refreshed and youthful appearance. Whether through non-surgical or surgical means, these treatments can be transformative, offering patients the opportunity to put their best face forward and embrace the aging process with confidence.

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