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Implants or Blepharoplasty for Tear Troughs? (photo)

29/F looking for a permanent solution for my under eyes. I have an indentation & thin skin making the area appear dark. I had a consultation with a plastic surgeon and he gave me three options: 1. Temporary filler 2. eyelid surgery with fat grafting 3. custom tear trough implant. I am leaning toward the implant because I've been told the body eventually absorbs the fat because there is no blood supply. I'd appreciate a second opinion on what the right course of action would be. Thanks!

Doctor Answers (16)

Fillers probably your safest choice.


It is impossible to say for sure without examining you, but I tend to agree that the irregularity along your tear trough is not prolapsing fat, but rather the contour of your eye socket bone.

Fat grafting can be a very good long term solution [about 50% of the fat will become permanent] but you need a very experience surgeon, as irregularities can occur here with the skin being so thin.

Using fillers are probably your safest bet as they can be reversed easily if you are not happy with the result.

Seattle Oculoplastic Surgeon
5.0 out of 5 stars 23 reviews

Fat Grafts for Tear Troughs

Structural fat grafting is a process where fat is deposited droplet bt droplet and the fat will create a blood supply and become permanent. The results can be beautiful and natural. It is important to find a plastic surgeon with expensive experiences and expertise in this area.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.5 out of 5 stars 42 reviews

Placing a tear trough implant will be a huge mistake.


Depending on how the implant is placed it could be a total disaster.  The tear through implant was great when introduced 25 years ago.  It was all we really had to augment the hollow under the eye.  It was a helpful method.  However, it was less than ideal.  The implant when placed through the mouth was associated with implant infections and nerve damage.  The implant was somewhat replace with midface lifting methods.  However, what really replaced this method is hylauronic acid fillers.  Yes these need to be topped off every 1 to 2 years.  But this is an office service.  If there is a lump or bump, it is easily adjustable.  It is important for you to understand that there is no permanent here.  I have not examined you but I am impressed how thin your lower eyelid is.  This increases the risk that the implant contour will be visible through the skin.  The bump in the lower eyelid that surgeons here would like to remove as fat is actually your orbital rim.  You can confirm this by putting your finger on this bump.  If it is hard, it is the orbital rim, not fat.  You are also not well informed to think that grafted fat will disappear.  No the problem with grafted fat is that it can be lumpy especially in a thin eyelid and require surgery to fix.  I would encourage you to think about fillers and try them out.  Finally, who does the service is very important.  Not all injectors are the same.  You are asking for your face to be sculpted so you need a fussy artist to do this.  Hope this information helps.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
5.0 out of 5 stars 18 reviews

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Tear trough

Absolutely do not get tear trough implants.  I know several surgeons who have tried them and learned the hard way that they are a mistake.  I'm also not a fan of fillers.  I recommend if anything removing the excess fat from the lower lids.

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Sunken Lower Lid Correction

The depressions that cast shadows of your lower lids can be improved with implants, fillers or fat preserving blepharoplasty either transconjunctival or incision beneath lash line approaches. Implants were very popular a decade and longer but because of less invasive techniques they have fallen out of favor by the majority of surgeons for tear trough correction. 
Regarding fillers:. In this area it is very important to have an experienced injector so as not to place the filler too close to the skin. I would recommend trying Jeuvederm or Restylane first as they are not permanent and can be reversed if you do not like the result. If you do like the result, then fat transfer is a good option for a more permanent correction. The blood supply to this area is very good and the survival though differs from person to person has been estimated at 75-85% in this area.

Larry S. Nichter, MD, MS, FACS
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Holding the camera high and looking up at it creates pseudo scleral show and pseudo fat herniation.  We can only give you bad advice with these photos.  A careful hands on examination is essential to give quality advice. Photos should be straight on for general advice.  Best wishes. Knowledge is power.  Luis F. Villar MD FACS

Luis Villar, MD
West Palm Beach Plastic Surgeon
4.5 out of 5 stars 7 reviews

Tear Trough Implants


Tear Trough Implants are old school, but can certainly be used by experienced Cosmetic Surgeons.  However, Mid-Facial procedures, Fat Grafts, Facial Injectables, including Blepharoplasty approaches should be discusses with you.

Robert Shumway, MD
San Diego Facial Plastic Surgeon
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Negative vector


You have scleral show in all of your pics. Being not age related I feel this is anatony of the underlying bones or increasing the positive vector (  like placing a finger over your lower lid.. This would help the progenitor of several problems. I would not do surgery today but rather a shelf of sculptra close to the eye on the bnone and Juvedern neat the rim. Watch the lower lid rise!    In the past transcong fat redistributuion helps and does elevater the lid but not enough there.   I agree tear trough implants are exactly the cure but far too many problems.


Good luck

PS you are a bear trap waitiing for most surgeons.

J. Smythe Rich, MD
Columbia Plastic Surgeon
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Lower Lid Blepharoplasty with Fat Transposition


A transconjunctival lower lid blepharoplasty with fat transposition would be my preferred approach.  While a hyaluronic acid filler like Beletaro Balance, Resteylane or Juvederm my temporarily fill the tear troughs, they never look as natural and certainly do not rival the longevity of surgery.  The surgery only takes about 45 minutes to one hour.  The incision is inside the eyelid where you cannot see it. I have provided a link below to a patient close to you in age.  Happy to see you if you wish in Stoneham or Worcester.

Stuart H. Bentkover, MD
Boston Facial Plastic Surgeon
5.0 out of 5 stars 18 reviews

Blepharoplasty / Tear Troughs


Tear trough implants are rarely used these days. Your best options to correct the loss of volume in the lower eyelids and tear trough region is to use an injectable filler for a temporary result, or fat grafting for a longterm improvement.


Jamil Asaria

FACE Cosmetic Surgery

Toronto, Ontario

Jamil Asaria, MD
Toronto Facial Plastic Surgeon
5.0 out of 5 stars 46 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.