Tear trough deformity of the lower eyelid is one of the most difficult depressions to correct surgically. The thin skin of the trough, the overhanging abundant lower lid fat, the underlying cheek mound, and the tethering effect of the orbitomalar ligament create a surgical challenge. Until now, noninvasive methods used to treat this depression have been problematic, yielding a poor benefit-to-risk ratio in most hands. Even surgery does not completely manage this depression. The most common surgical techniques for lower eyelid rejuvenation do not even address it. Since December of 2003, 24 patients have had their tear troughs treated with injectable hyaluronic acid. For 23 patients, Restylane was injected superficially to elevate the surface from the orbitomalar ligament and add volume to the trough. Only two patients were dissatisfied with their results.