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Blepharoplasty or Filler in the Tear Trough?

asked 2 years ago by cravingbeauty in Milwaukee, WI
Latest answer by Michael Law, MD
Question viewed 5,596 times
Tags: age 35-44, eyelids, tear trough, under eyes, female, eye bags, sunken

I HATE my under eye bags. They are genetic. I want to have them fixed. My aunt had it done but 10 yrs. later she has hollow, sunken orbital area. I don't want that so I am considering having a filler put in my tear troughs, but I've heard horror stories. I've tried every type of cream, home remedy, etc.

I'm 39 and I don't want to look like I'm in my 40's. I'm attaching a pic taken with light over my head so you can see the bags well. Suggestions?

31 answers to Blepharoplasty or Filler in the Tear Trough?

Arcus Release and Fat Grafting Best for Tear Trough Avoid Filler Injection

Thank you for your email. I do see the depression beneath your lower eyelid called the Tear Trough and the puffiness of the lower eyelid above the depression. Some call this Dark Circles under the Eyes. This is best treated with the Transconjunctival Blepharoplasty with Arcus Release and Fat Grafting. See the link below for a detailed explanation of the correction of Dark Circles under the Eyes. Filler injections into the lower eyelid are dangerous in inexperienced hanbds and can... more

Brooke R. Seckel, MD
Boston Plastic Surgeon

www.drseckel.com

Blepharoplasty better for you overall with the right surgeon

I think surgery is the better choice for you and here's why: You have an abundance of fat that can be used to reposition over the hollow areas under your eyes and in your tear troughs. This method avoids the over-hollowing some patients experience. The fillers are fine but do not last very long and have a high risk of bruising (so does surgery but at least it's a one time thing). Just make sure you see a surgeon who is not overly aggressive about fat removal and more conservative in the... more

David W. Kim, MD
Bay Area Facial Plastic Surgeon

Lower lid blepharoplasty or dermal fillers

There are many valid arguments for each type of approach to rejuvenating the eyes in lower lid Blepharoplasty. You are young and it is clear that the herniated fat that your lower eyelids exhibit is genetic in origin. You are definitely a candidate for filler in this area but, you are also a fantastic candidate for a conservative transconjunctival Blepharoplasty of the lower lids. If you have dermal filler placed in the lower lids, you will need to have the procedure repeated every 7-9... more

Philip S. Schoenfeld, MD
Chevy Chase Facial Plastic Surgeon

Eyelid surgery with fat transfer would give the best result

Fillers can help disguise the bags but have a risk of irregularities. You note that your aunt has a hollowed out look, and this is the reason that I would recommend not removing fat from your lower eyelids, but rather transferring fat to fill out the tear trough grooves (the grooves between the lower eyelids and the cheeks). This has the combined benefit of getting rid of the puffiness, putting the fat to good use to fill out the grooves between your lower eyelids and cheeks, and preserving... more

Michael D. Yates, MD
Huntsville Plastic Surgeon

You would benefit from a combined approach

You have excess fullness in the inner half of both lower lids. You also have hollowness under the eyes in the tear tough area. In my practice we would advise that you not have a blepharoplasty alone but rather a lower lid fat repositioning (sometimes called a fat pedicle transfer). In this procedure the lower lid fat pedicle is rotated and transferred to the tear tough area. This combined approach reduces fullness in the lower lids–where you do not like it–and adds fullness to... more

J. Timothy Heffernan, MD
Seattle Oculoplastic Surgeon

drtimheffernan.com

Under eye bags

A very common aging change in the lower eyelids is the development of 'bags', which are in most cases due to an outward bulging of the fat pads behind the lower lids. These 'bags' of fat can be improved by conservative removal through an invisible incision on the inside of the lower lid (trans-conjunctival approach) in patients that do not require skin excision, or through the under-eyelash (sub-ciliary approach) in patients that are having some excess lower lid skin removed... more

Michael Law, MD
Raleigh-Durham Plastic Surgeon

michaellawmd.com

Sunken eyes after blepharoplasty result from old-fashioned surgery

The result that you don't like in your aunt is only because she had fat removed--which is what we did all the time 20 years ago. Now we pay much more attention to fat preservation and transposition--moving the fat so that it fills the tear troughs--and the sunken eye problem is much less common. Fillers will buy time. They are less expensive but temporary. Your decision just depends on what you can handle in terms of time and expense. Ultimately... more

Mark B. Constantian, MD
Nashua Plastic Surgeon

Blepharoplasty vs. Fillers

It appears from your photograph that you would be an ideal patient for a transcongetival lower lid blepharoplasy with minimal fat removal. It is as important how much you take out as what you leave behind as you have seen in your aunt. I think you would have an excellent result from this and would stay away from any fillers in the tear trough for your current complaints. Blepharoplasty is a wonderful surgery with great results in the hands of a skilled surgeon. Make sure while consulting... more

Michael Elam, MD
Orange County Facial Plastic Surgeon

Fillers work well in the tear trough of the right patient

1. From your photo it is tought to tell exactly what you need but a filler such as juvederm may improve your cosmetic problem in that area quickly and with minimal downtime. 2. A transconjuctival bleparoplasty with fat transposition would likely give a longer lasting solution

Dev Wali, MD
Los Angeles Plastic Surgeon

Filler vs lower bleph

I recommend lower blepharoplasty with fat preservation. The problem with your lower eyelid is that the fat is bulging through the weak septum. This can be tightened or released to ameliorate the problem. Fillers are not dependable in this area and have a higher risk of complications.

Samer W. Cabbabe, MD
Saint Louis Plastic Surgeon

Transconjuntival Blepharoplasty (the hidden or concealed incision lower eyelid tuck)

I would agree with Dr. Aldea. The decision comes down to a topographic decision. Is the prominent orbital fat the problem or the sagging cheek fat creating a depression? In my opinion, it appears that the prominent orbital fat is the main culprit. Conservative removal of the fat should be a realitvely simple and long term solution. This can be done through a concealed incision behind the eyelid. The Restylane could be injected at a later date if the cheek fat is also responsible.... more

Otto Joseph Placik, MD
Chicago Plastic Surgeon

Transconjunctival Blepharoplasty and Restylane to the Tear Trough

I think you would do best with a careful, minimal, precise lower lid fat removal via a Transconjunctival Blepharoplasty. That would reduce the baggy fat pseudo herniation of the lower lids. Once the swelling has disappeared, I would re-asses and if needed, add Restylane to the tear troughs to fill the nasojugal line depression. Dr. P. Aldea

Peter A. Aldea, MD
Memphis Plastic Surgeon

Lower blepharoplasty with fat preservation

Based on your photo, a lower blepharoplasty would be the best procedure for you; not a filler. The type of blepharoplasty would preserve your fat and reposition the fat; not remove fat. This can be done through an incision on the inside portion of your lower eyelid with no external scars or incisions. You do not need any skin removal either. The lower portion of the eyelid which is causing this appearance (septum) needs to be tightened with sutures, this will create a natural appearance and... more

William Bruno, MD
Beverly Hills Plastic Surgeon

Blepharoplasty or filler to correct tear troughs

Tear troughs should not be filled with dermal fillers for fear of injecting into the orbital fat, which will then be present for years and will not want to dissipate. A simple transconjunctival lower blepharoplasty can be performed where the fat is removed through the inside incision of the lower lid. It is important not to take out too much fat; otherwise, a sunken orbital area will result. There are no creams and lotions that will help. It is important to make sure that any... more

William Portuese, MD
Seattle Facial Plastic Surgeon

www.seattlefacial.com

Bulging Fat: Think Blepharoplasty

I personally think fillers in the tear troughs are very over-rated, especially in a situation where there is obvious orbital fat pseudoherniation. Fillers will definitely not deal with this problem and may exacerbate the puffy look. Lower lid Blepharoplasty is a much better choice in this particular circumstance: it can be performed skillfully with judicious fat removal and appropriate elevation of the upper cheek in order to minimize the lid-cheek junction.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon

www.drprendiville.com

Injectable Fillers work well for minimizing the appearance of lower eyelid bags.

Lower eyelid blepharoplasty with removal of fat can often lead to a hollow, operated appearance. Injectable Fillers work by filling the lower eyelid groove (tear trough) that forms between your eyelid and cheek. You should consult a board-certified physician experienced in the art of filling this delicate area. Procedures are painless, and there is usually no downtime. Patient satisfaction is very high when performed correctly. I've attached a link to my Injectable Filler photos for your... more

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon

Blepharoplasty or tear trough filler

Your photograph clearly demonstrates bulging of fat in the lower eyelids. Fillers in the tear trough can help reduce the appearance and camouflage the fatty prominence in the lower eyelids. But there is risk of irregularities from the filler. However, in your presentation I would strongly urge a lower eyelid blepharoplasty. The transconjunctival approach can remove the fat through hidden incision. A light laser peel at the same time would help tighten the skin. If on examination, the... more

Andrew Turk, MD
Naples Plastic Surgeon

Tear troughs can be treated with surgery or with fillers

Your photo shows fullness of your lower lids, which is hereditary by your history. Your question is a really interesting one because you are rightly concerned about the overly respected look your aunt developed as she aged after her lower lids were corrected surgically. Things in plastic surgery have changed over time. We have come to understand that the aging of the face involves not just loosening and wrinkling of the skin and pouching out of fat in places where we don't want it, like... more

Elizabeth Lee, MD
Bay Area Plastic Surgeon

Under the Eyelid Bags

Judging by the photos, if you were to come see me, I would recommend transconjunctival blepharoplasty. This means making an incision on the inside of the lower eyelid and addressing the fat pockets. This will smooth out the lower eyeds and refreshen your look. Good luck.

Farbod Esmailian, MD
Orange County Plastic Surgeon

Lower eyelid surgery for fat bags

It looks like from your pictures you have a condition called hereditary fat pseudoherniation. While fillers might help temporarily with the tear trough region, they will make your entire lower eyelid look puffy overall. You are correct in that you have a tear trough as well as excessive fat in your lower eyelids. In my opinion, the best approach for long term correction would be what is referred to as a transconjunctival lower blepharoplasty. In this procedure, an incision is made behind... more

Scott Trimas, MD
Jacksonville Facial Plastic Surgeon

Blepharoplasty for lower eyelid bags

There are probably as many ways to treat this as there are doctors. The cause is age weakened or genetic weakened tissues that cannot hold that fat back into the eye socket where it cushions the eyeball. If you just take the fat out, which was the standard treatment for 40+ years you tend to end up with a sunken look over time and more visible bone rim under the eye. My preference is to free up this fat and sew it to cheek fat on the other side of the bone rim under the eye. Sometimes I also... more

Aaron Stone, MD
Los Angeles Plastic Surgeon

Blepharoplasty would be my choice for your fat pads

From your excellent photograph I would guess a transconjunvtival lower lid blepharoplasty is my choice. This allows removal of the 3 fat pads from a hidden incision, with extremely fast healing. Go see 3 boarded surgeons for in person evaluations. Regards and Happy New Year!

Darryl J. Blinski, MD
Miami Plastic Surgeon

Blepharoplasty and or fillers

A blepahroplasty would be ideal to remove some of the fat that appears to be herniated. The depressions below the fat may be camouflaged with fillers but you have to be careful when having it injected.

Steven Wallach, MD
Manhattan Plastic Surgeon

Nothing like a personal consultation

Dear Craving, Conservative transconjunctival lower blepharoplasty with a arcus marginalis release and a chemical peel probably represents your best value. However, the vast majority of my patients in your situtation would elect to have under eye restylane to avoid the need for surgery. At some point in the future, surgery will be a better option but for quite some time, under eye Restylane will bet the job done. You may need between 3 and 4 milliliters of Restylane.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon

Blepharoplasty or filler for tear trough

This is an excellent question and thanks for the photos. I have treated several patients with exactly this situation. In these cases, I have done a very conservative fat removal and injection of the tear trough at the same time. However, keep in mind that if you only fill in the tear trough, it will help a lot and you may be able to postpone surgery for a while. By filling in the trough, the bulging fat will not be as obvious. If you do have surgery, the key as you already know, is to have... more

Tracy Pfeifer, MD
Manhattan Plastic Surgeon

Lower eyelid rejuvenation

Soft tissue fillers like Juvederm or Restylane will give you a temporary correction of the tear trough deformity and will help to delay a surgical correction. The key to a successful correction of your lower eyelid condition would include: 1. Maintaining and creating fullness of the lower eyelid and lateral orbital area. 2. Tightening of the underlying orbicularis oculi muscle of the lower eyelid 3. a conservative removal of excess skin of the lower lid 4. Redistribution of the protruding... more

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon

Stay away from fillers for tear trough

You have prominent lower lid bags that are fat pockets that can be corrected simply with a transconjunctival(no external scar) blepharoplasty. See a well qualified board certified plastic surgeon with experience doing this and you should look great after. Happy New Year.

William B. Rosenblatt, MD
New York Plastic Surgeon

Deciding between Blepharoplasty or tear trough fillers

The photo is helpful, but not a substitute for a consultation. One of the reasons that long-terms issues can arise after a bleph is if the fat is removed, you can get a sunken eye. The trend now is to preserve the fat, and tighten the septum that allows it to bulge when it is lax. That would be a very good solution for you. Fillers are often a good way to "buy time" but eventually the bleph would probably need to be done. What I see in the picture is a shadow line along the upper... more

Richard Baxter, MD
Seattle Plastic Surgeon

Blepharoplasty and fillers do different things

Your photo appears to show clearly bulging lower eyelids. This is usually the result of herniation of fat into the eyelid which is corrected surgically with a blepharoplasty. In younger patients with taut skin this may be done through an incision inside the lid, avoiding a visible scar. Fillers have a role in treatment of the midface and tear trough which is to fill in depressions, not correct a bulge.

Mark Beaty, MD
Atlanta Facial Plastic Surgeon

Both blepharoplasty and fillers have merit

Hi, Thanks for the photo - it is really helpful. It shows that you have significant bulging on the lower eyelid fat compartments. Blepharoplasty can provide great long-term results. Different surgeons will tell you different things about the specifics of the operation, but the keys to the operation are as follows: Eliminating the lower eyelid bulges. This can either be through removal of fat, like your aunt had, or by tightening the septum which holds the fat in place. If fat is... more

Sam Jejurikar, MD
Dallas Plastic Surgeon

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