Foglietti Fostyk Plastic Surgery | 22901 Millcreek Blvd. Suite 145, Beachwood, OH 44122

Ask The Surgeon, Cleveland Magazine

Question: For years I’ve had a minor amount of puffiness under my eyes. It was not always a problem, I just sometimes looked run down. However, I recently noticed that I’ve developed what looks like a sunken line or ring underneath the puffy part of my lower eyelid. I thought the puffiness made me look tired, this sunken ring makes me look downright old! How can this be treated?

Answer: What you’re describing sounds like a tear trough deformity. I’ve had patients refer to this as deep circles under their eyes. A tear trough deformity becomes evident when the lower eyelid becomes puffy and a depression underneath it forms. This is a result of age, heredity, and/or chronic fatigue.

The treatment has historically been a lower eyelid lift (blepharoplasty) with or without fat tissue placementto smooth the area. Eyelid surgery is invasive and requires healing time but does give a long lasting result.

Thankfully, there is now a non-surgical treatment that can improve the appearance of the lower eyelids by a simple injection of HA (hyaluronic acid) filler into the tear trough deformity. The result is not as good as it is with the surgical option but can give a significant improvement and in many cases delay the need for 
surgery by several years.

The injection of HA filler into the tear trough can be performed in the office with no anesthetic required. This procedure takes minutes to perform, and results are evident within days. Patients should not exercise for at least 24 hours after injection, as this can result in swelling and bruising. Bruising is possible anytime a needle is used to inject into the skin.

This particular procedure is one of the more difficult injection techniques to learn, requiring a precise and conservative approach, so your practitioner should have significant skill and experience. The results of 
this treatment can be excellent and without the risks associated with surgery.

Get Social With Us


22901 Millcreek Blvd. Suite 145
Beachwood, OH 44122


(216) 292-6800

Office hours

Monday 9:00 am - 5:00 pm
Tuesday 9:00 am - 5:00 pm
Wednesday 9:00 am - 5:00 pm
Thursday 9:00 am - 5:00 pm
Friday 9:00 am - 5:00 pm
Saturday Closed
Sunday Closed