The Difference Between Dark Circles and Tear Troughs

If you undergo lower eyelid fat repositioning surgery, not only the hollow under the eyes but also dark circles can be partially improved. But do you know why tear troughs form and how they are different from dark circles? I’ll explain the differences between the two and, along with reviews of lower eyelid fat repositioning, introduce how much improvement can be expected from lower eyelid fat repositioning in improving under-eye wrinkles.

1. What is a tear trough?

A tear trough refers to the semicircular, depressed wrinkle on the side of the nose under the eyes. As we age, the fat atrophies and sinks, making the under-eye骨 structure more visible. It generally tends to become more noticeable from the late 30s onward. This condition accentuates a shadowed, tired look under the eyes.

2. Why do tear troughs form?

In the facial bones, there is an orbital retaining ligament that holds and supports the tissue around the eyes. This retaining ligament, which forms a round shape around the eyes, is not very noticeable when you are young, but as aging progresses and the fat around the ligament atrophies, it becomes more visible externally.

The retaining ligament surrounding the eyes (right eye)

3. Differences between dark circles and tear troughs

Dark circles refer to the dark shadow under the eyes. They often appear temporarily due to overwork, lack of sleep, or stress, but they can also occur because of genetics or aging. If the causes are classified from the perspective of treatment methods, they can be divided into the following three categories:

• Pigmentation of the skin itself

• Visibility of underlying structures because the skin is thin

• Shadowing caused by a hollow under the eyes

If dark circles have been visible since a young age, the causes in items 1 and 2 above should be considered. Skin pigmentation can be improved with laser toning or Genesis, and visibility caused by thin skin can be treated with dark circle treatment using nano fat (a type of fat grafting in which the fat particles are made smaller than in regular fat grafting). If item 3 is the cause, lower eyelid fat repositioning or lower blepharoplasty is needed.

However, in reality, the causes of dark circles are often mixed, which makes it difficult and often requires combining multiple procedures.

A case where lower eyelid fat repositioning, nano fat grafting, and laser treatment were performed together

4. Do the under-eyes get longer as we age??

When we are young, the boundary between the eyelids and cheeks is not very distinct, but as we age and hollowing under the eyes and tear troughs appear, it can feel as if the under-eye area has stretched.

The author’s appearance: 20s vs 40s

Typically, this kind of under-eye hollowing and sagging is treated with lower eyelid fat repositioning or lower blepharoplasty.

But if, like in my case above, there is no fat available for repositioning, I clearly explain the limitations of surgery and recommend fat grafting. This conclusion comes from reviewing my patients’ lower blepharoplasty reviews and lower eyelid fat repositioning reviews over time, and more details can be found here.

5. Lower eyelid fat repositioning vs. lower blepharoplasty: Differences

The difference between lower eyelid fat repositioning and lower blepharoplasty

Both surgeries improve aged-looking under-eyes. However, as shown in the figure above, they are divided depending on whether the incision location is on the inside or outside.

Improvements achieved with lower blepharoplasty

As shown in the figure above, lower blepharoplasty improves three things: skin laxity, fat bags, and tear troughs. Lower eyelid fat repositioning, which does not involve an incision on the skin surface, is a surgery that treats the two issues other than skin laxity.

6. Fat repositioning

Both lower blepharoplasty and lower eyelid fat repositioning use protruding fat as material to fill in the sunken tear trough. Because the procedure moves fat from an area where there is too much to an area that is hollow, it is called fat repositioning.

A schematic diagram of fat repositioning performed during lower blepharoplasty

A schematic diagram of fat repositioning performed in lower eyelid fat repositioning

However, the amount of fat differs from person to person, and for eyes that do not have enough “material” to fill the hollow area, it can be difficult to achieve the expected result without fat grafting. In addition, if dark circles are a concern, it would be even better to treat the under-eye area by using fat grafting.

6. Summary

• Dark circles are used as a term that refers to various causes (pigmentation, hollowness caused by tear troughs, etc.). In congenital cases, pigment laser treatment should definitely be considered. In acquired cases, because multiple causes may work together, it is best to prioritize combining several treatment methods.

• Tear troughs are a sunken shadow under the eyes and one of the signs of aging, and they are also a cause that makes dark circles stand out more. Treatment varies and includes lower blepharoplasty, lower eyelid fat repositioning, and fat grafting.