How I Quit Crying About My Tear Troughs
Sometimes concealer just won't cut it. With the help of plastic surgeon Jason Roostaeian, MD, one writer investigates the best way to get rid of her dark circles for good.
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My concealer and I have a complicated history. I started swiping it on around age thirteen, to cover the under eye circles that had begun making me self-conscious. I spent the next thirty years completely addicted to the camouflage. I stashed sticks in my pocket, carried liquids in my purse, and even took compacts on camping trips. When I looked in the mirror, all I saw was those sad circles making me I look more tired than I felt. I never gave up hope that I would eventually find some magic serum or miracle cream to banish them for good.
The older I got, the more makeup I needed and the less it helped. Finally, I raised the white flag and made an appointment with UCLA plastic surgeon Jason Roostaeian, MD, who explained to me that my dark circles were due to a combination of genetics and aging. Some people are born with thinner skin and less fat in the under eye area, “an issue that’s compounded by the aging process," he said. "Fat loss and redistribution, combined with increased skin laxity, start to form a depression at the lower eyelid and cheek junction, commonly known as a ‘tear trough deformity.’” When asked about my treatment options, he suggested non-surgical injections of hyaluronic acid filler to smooth that depression and thereby minimize my dark circles.
I was skeptical about such a simple solution. I also wondered about the risks. Dr. Roostaeian explained that minor bruising and swelling is common, but typically goes away in a couple of days. “Because of the proximity to the eye, it’s imperative that your tear trough treatment be performed by a highly trained professional who has a comprehensive understanding of facial anatomy," he said, since sever side effects, though extremely rare, are possible. "If filler is inadvertently injected into a blood vessel, your skin could die or you could go blind. That’s why I go down to the bone. The blood vessels are located in the tissue between the skin and the bone. So when I inject deeply, there’s much less chance that I’ll penetrate a vessel.”
Wary about starting a cosmetic treatment habit, I asked Dr. Roostaeian about the cost. “In most cases, filling the tear trough area requires about one syringe of product, which ranges between $500 - $1000,” he said. I thought about the price of three decades of products - the concealers, the serums, the creams - that never delivered on their promises, not to mention the time spent applying those products. The cost difference didn't seem to be all that much.
With a mirror, Dr. Roostaeian showed me exactly where he performs tear trough injections. Tracing a gentle arc along the top ridge of my cheekbone, he explained that typically a tear trough deformity is most pronounced in the area adjacent to the nose and becomes less depressed as you move outward. He also pointed out my mild fat displacement that was causing some shadowing, the first sign that I was developing those puffy lower eyelid “bags.” He told me that sometimes patients seeking tear trough treatment actually need lower eyelid surgery (blepharoplasty) to have those fat pads excised. “Good candidates for filler are patients whose dark circles are primarily caused by a depression, rather than excess eyelid fat creating shadows,” he said.
When it comes to age-related volume loss within the eye socket itself, Dr. Roostaeian doesn't typically recommend dermal filler. “It’s risky to inject directly into the lower eyelid area because it’s the thinnest skin on your body," he said. "So you’re putting bumpy drops of gel in between that thin skin and the muscle beneath, which is resting on top of nothing. It’s your eye socket. Some doctors will dilute the filler to try to attack the issue from both sides, but it’s unpredictable. There’s also a risk of what’s called the ‘tyndall effect,’ a bluish tint that’s caused when filler is injected too superficially and causes it to show through that thin skin.”
Once I understood the potential benefits and risks of tear trough treatment, I decided that the prospect of being permanently rid of my dreaded dark rings was too tempting to pass up. After numbing the area with ice to reduce pain, swelling and bruising, then disinfecting with an alcohol pad, Dr. Roostaeian injected small amounts of filler along the upper edge of my cheekbone. There was some pain, but it wasn't unbearable. What surprised me was the sound. There was a crunching that Dr. Roostaeian informed me was caused by the needle penetrating dense tissue known as fascia. I sat still in spite of it as Dr. Roostaeian hovered over me, injecting, pausing, smoothing with his fingertips, and pausing again before proceeding with the next needling. The whole thing took about fifteen minutes. When he instructed me to ice again, I asked why he hadn't used numbing cream. “Topical numbing agents applied to the lower eyelid are certainly an option, but they can take between 20 to 45 minutes to reach their optimal effectiveness," he said. "Most of my patients do fine with a bit of ice before and after, without having to sit around and wait for the cream to work.”
When Dr. Roostaeian held out the mirror so I could view his handiwork, I was stunned. I looked like me, but more vibrant, refreshed, younger. I could already detect tiny purple bruises popping up marking the syringe sites, but I didn’t care. When I questioned him about it, Dr. Roostaeian explained that some doctors use a cannula (a blunt-tipped syringe) to administer filler because some believe it lowers the risk of bruising. “There are pros and cons to using a needle versus a cannula,” he told me. “A cannula, with its blunter tip, may be less likely to penetrate a blood vessel, but it’s still possible. I prefer to inject filler with a needle, because it provides me more precision and control.”
Dr. Roostaeian cautioned me to keep the area free of germs and makeup and to avoid alcohol and any medications that thin blood for the next day or so. But how long would these non-surgical results last? “Generally, tear trough filler lasts about six months to a year,” he said. “I tell patients it’s like a tank of gas. You fill it up, but then as soon as you start driving, the tank starts depleting. When you need a follow up depends on when it starts to bother you again. At that point, I adjust the amount of filler injected during each subsequent visit, so we always achieve a natural result that’s not puffy or over-filled.”
During my drive home, I kept stealing glances at myself in the rearview mirror. I now understand that even a small adjustment can be truly transformative. The relief of no longer worrying about my tear troughs allowed me to realize how much time I’d spent physically trying to disappear my dark circles and how much more time I’d spent thinking about them. Now, waking up every morning looking refreshed has been life changing.