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.




