The tear trough is a ligament extending from the facial bones to the skin. A youthful face demonstrates a smooth curve and transition from the lower eyelid to the cheeks. The tear troughs can become more visible with the drooping of cheeks and the development of lower eyelid bags, both of which breaks that smooth transition. The extended deep plane facelift can improve the appearance of the interface between the lower eyelid and cheeks. However, lower eyelid bags are the primary contributor to deepened tear troughs. Therefore, one should not expect the extended deep plane facelift to treat their deep tear troughs. Lower eyelid surgery (blepharoplasty) is generally the best treatment for deep tear troughs.