Implants or Blepharoplasty for Tear Troughs? (photo)

Question

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!

A.J. Amadi, MD · Answer

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.

Jamil Asaria, MD · Answer

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

Ronald J. Edelson, MD · Answer

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.

Larry S. Nichter, MD, MS, FACS · Answer

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.

Luis Villar, MD, FACS · Answer

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

J. Smythe Rich, MD · Answer

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.

Eric M. Joseph, MD · Answer

Based on your photos, you should be cautious before considering any type of lower eyelid surgery. You have scleral show, which means that you can see the white of your eyes between your lower lid margins and irises. Scleral show may worsen with lower blepharoplasty.

	You appear to have typical lower eyelid grooves that may be improved by a well-performed injectable filler procedure. You should make sure your doctor is experienced in the delicate art of filling lower eyelid grooves, as this area may be quite unforgiving. My personal experience in this area is with Silikon-1000, an off-label filler for permanent results.

	Hope this helps.

	Dr. Joseph

Kenneth D. Steinsapir, MD · Answer

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.

Toby Mayer, MD · Answer

Tear trough deformity in young woman with small amount of fat is best handled by transconjunctival blepharoplasty with fat repositioning. BUT you could try as I do with my patients putting saline or numbing liquid in the trough first. That way if you like it you can wait for surgery and just have filler.

Robert W. Sheffield, MD · Answer

Thank you for your question and photo attachments. It is always an excellent thing to look for second or third options. The first thing that you need to understand is that procedures like this require surgeons who are board certified as well as have experience under the subject under their belts. The second thing you need to keep in mind is that you have trimmed down several good options.    Fat grafting, on the other hand, is a good option if you are looking for long term answer. However, this is a crucial procedure as only a highly experienced surgeon will be able to do it flawlessly.  Finally, implants are not widely used as of today. It is one that I am also not using either so this is not something that I will recommend.  Fillers are possibly the safest among the 3 options you mentioned. The results also look natural. This option is reversible should you not be happy with the result. Hope this helps!

Implants or Blepharoplasty for Tear Troughs? (photo)

Answers (17)

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