There are many options for dark circles under the eyes or a prominent tear trough. There are options from skincare, laser, and filler which are non-surgical to surgeries such as lower lid blepharoplasty with orbital fat pad repositioning or injection of fat grafts. Each option has positives and negatives. Orbital rim implants are theoretically permanent but risk extrusion of the implant. Fat grafting is a wonderful method to fill the tear trough and help to give a natural, rejuvenated youthful look. Fat grafting can also help with dark circles of the lower eyelid. Filler (hyaluronic acid such as Juvederm or Restylane) is temporary usually only lasting about a year but fat grafts are theoretically permanent and do not have the risk of encapsulation or extrusion like an orbital implant would. Dr. David Azouz has been rejuvenating lower eyelids in the Dallas Fort Worth area for over 35 years and will determine the best option for the patient. He does this with a detailed history and physical exam assessing the skin, soft tissue, and bony anatomy of the orbit and eyelid.