Contour Lower Lid Blepharoplasty

Richard Gentile, 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.


Richard Gentile, MD
7 months ago
By Richard Gentile, MD - Cleveland Facial Plastic Surgeon

In selecting a technique, I have evaluated all options to determine the best approach to lower lid contour issues, and I believe we have developed the best solution (in my hands). 

Because there is a bulge and a hollow in many patients like you, we reduce the bulge surgically and then fill the rims with microfat grafts or filler.  We have done this for the past few years with impressive results and high patient satisfaction. 

If there is excessive skin redundancy, we pursue this through an external skin incsion; if not (as in your case) a transconjunctival incision. 

This combination technique was first reported by a Swiss Plastic Surgeon, and we agree with his approach.

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