Tear-Trough Deformity, Malar Mounds, or Festoons

The hanging of cheek tissues can lead to a sunken in appearance of the lower orbital rim. This causes shadowing of the area below the eye.  This is known as the tear-trough deformity.  It is caused from a combination of the sinking of facial fat and lengthening of the lower eyelid skin. Patients notice that certain times of day, allergies, certain foods or alcohol may make the appearance more noticeable.  The graduated approach allows me to discuss patient goals and motivations in our treatment planning for this issue.

Treatment Options Include

1. Topical treatments and exfoliants – Topical Retin A and Hydroquinone can provide some modest improvement in skin discoloration. This may be started before or after surgical procedures depending on the extent of darkening that may be present around the eyes.

2. Injectables – There are a variety of fillers, however only a select few should be used to fill the tear trough and improve the shadowing that may be present. This procedure can be done in my clinic with immediate improvement in shadowing. Options include temporary fillers or fat injections. This does reduce any fat or swelling that may be present so discussion should be had in regards to what your best, cost-effective solution would be.

3. Lower eyelid surgery (blepharoplasty) – Often there may be a combination of excess skin and fat. Reducing the amount of “herniated” fat improves contour of the lower lid and decreases the bulging present while excision of skin can remove some of the excess skin and wrinkling. Fat Repositioning procedures are performed during lower blepharoplasty to fill the hollows beneath the eye and can substitute for fat removal procedures.

4. Resurfacing procedures – Fine wrinkles around the eyes is best treated with resurfacing procedures – either laser or chemical peeling is our preferred method. This can also be performed at the same time as surgery if needed.

5. Mid-face lift – This procedure addresses an often overlooked part of the youthful face, the midface.  Through a combination of eyelid incisions or small incisions made in the hairline, a lift of the cheek area can be performed.  This can address the region of the tear-trough as well as the shadowing just below the cheek bone (known as malar mounds).  This procedure is often done in conjunction with a lower lid blepharoplasty (eyelid surgery) to remove extra skin or with a brow lift.

6. Facelift – The most effective way to address sagging of the lower face, this procedure is performed through incisions hidden around the ear.  Extra skin is removed and the lower face is lifting into its natural position.  I avoid “pulled” or “stretched” results by replacing tissues in their natural position.  This can be demonstrated by pulling the tissues “up” rather than “back”.  See the Facelift Page for more information about how this procedure is performed, expected downtime, and results.

Schedule a Consultation with Dr. Rihani

We will work together to find the right solution for you.

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