Best approach for tear troughs

Harrison C. Putman III, MD answers: Best approach for tear troughs?

I am 30 year-old male with tear trough at lower eyelids, like dark circles. Last year, I developed some small bags that make the dark circles worse. I have no excess skin. I visited some plastic surgeons, and I was offered Restylane injections or arcus marginalis release with fat reposition (not transconjunctival, since bulging fat is very close to tear duct and hard to deal with through that approach). Is this correct? How close to the bone and inner corner of eyelid can Restylane injections go? My grooves start from the very inner corner next to tear duct.


Harrison C. Putman III, MD
7 months ago

For your specific problem I would recommend transconjunctival blepharoplasty with a pedicled fat repositioning with adequate arcus marginalis release. The pedicle maintains circulation to the fat graft, which is contoured to the tear trough deformity and secured with absobable pull-through sutures, usually 3-4.

These are removed in 3-5 days. There is more swelling and bruising, but a superior and more consistent result is achieved. I personally don't like fillers except for short term improvements in this area.

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