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Should I Have Blepharoplasty or Restylane on Tear Trough?

asked 3 years ago by eyebaghell in UK
Latest answer by Robert L. Kraft, MD
Question viewed 11,027 times

I am trying to decide if lower blepharoplasty (fat repositioning) or tear trough rejuvenation with Restylane is best for my problem? I have fat prolapse on my right side resulting in a more puffy appearance above the tear trough and on the left have more extensive hollowing.

I am just lost as to which gives best results. I am getting married in August & concerned with complications / recovery of the surgery but wonder if ultimately it is the better option? I have also been told that my mid face area seems to be attributing to the overall problem?

19 answers to Should I Have Blepharoplasty or Restylane on Tear Trough?

Restylane vs. surgery

The photograph is not completely telling because you are looking up and a bit to the side, which accentuates the bags under the eyes. Your eye configuration is one of a prominent eyeball (globe); hand in hand with a large eye is often a very visible fat bulge below the eyes. The most effective way to treat a bulge below the eye is with a transconjunctival blepharoplasty. That way the danger to the lower eyelid is very low. If you try to build up the areas surrounding the bulges with... more

Brent Moelleken, MD
Beverly Hills Plastic Surgeon

www.drbrent.com

I'd recommend the fillers

As said before, you are showing your eyelids in their most unflattering pose. Even here, though, I don't think you have enough fat to reposition and effectively hide your tear troughs. In my opinion you would still need fiiler so why not just do it all with the fillers in the first place. It eliminates the risks of eyelid surgery which are higher in the lower lids and sometimes are hard to correct. Even though they need repeating, the results are actually better looking that what surgery... more

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon

Transconjunctival Blepharolasty with arcus release and fat grafting

I do not recommend filler injections into the tear trough. While many doctors do them I have seen many complications such as visible lumps and discolorations. Blindness following filler injection around the eye has been reported in England. The transconjunctival blepharoplasty with arcus release and fat grafting or repositioning is the most effective treatment for dark circles and tear trough deformity. The puffiness of the lower lids will be corrected as well. See before and after pictures. more

Brooke R. Seckel, MD
Boston Plastic Surgeon

www.drseckel.com

Save yourself and don't have lower eyelid surgery.

Dear Eyebaghell First it is not possible to position your face in a more unflattering manner. Looking up brings out the lower eyelid fat. So this will be your lower eyelid bulges at their absolute worst. Second, there is no substitue for a personal consultation. Having said that, the biggest problem you have is a relative weakness in the projection of the orbital rim at the top of the cheek. This makes this area lack aesthetic strength and accentuates the tear though area. The arcus... more

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon

Eyelid surgery v Restylane

I agree that the photo isn't the most flattering but you should see how the Dept of Motor Vehicles captured me on my license picture! Either procedure would improve your appearance but I generally recommend that patients try a Restylane treatment initially. It's inexpensive, has basically no downtime and may give you an improvement. If you want to enhance the appearance of your eyes even more, then surgery is definitely an option. Congratulations on your forthcoming marriage! more

Robert L. Kraft, MD
New York Plastic Surgeon

Tear troughs and blepharoplasty

The approach to the tear troughs is a complex question and is dictated by the patients individual anatomy and characteristics. Common techniques that are approached by themself or in conjunction include: Correction with filler (fat, HA) (See below weblink for just filler) Reposition of fat Removal of fat lower eyelid All of the above are extremely technique sensitive and both the choice and application of the technique are surgeon dependent. ... more

Anil R. Shah, MD
Chicago Facial Plastic Surgeon

Blepharoplasty a better solution

A blepharoplasty is a permanent solution to the tear troughs and fat bags underneath the lower eyelids. It appears in the picture that you do have herniated fat in the lower lids and tear troughs. Your midface area is also somewhat shallow and could be improved with cheek implants. We do not advise Restylane in the tear troughs because of complications that are associated with it, and it is only temporary.

William Portuese, MD
Seattle Facial Plastic Surgeon

www.seattlefacial.com

Angle of picture makes it difficult to tell

Hard to answer this question based only on the picture you provided, but both techniques can give excellent results in well-chosen patients. A physical examination by a surgeon would be most helpful to determining which is right for you.

W. Tracy Hankins, MD
Las Vegas Plastic Surgeon

I believe restylane done correctly would give a quick result with little downtime

In my opinion the best result will be achieved with transconjuctival fat removal of the lower lid fat pads in combination with fat transfer to the tear trough in the same session. Restylane injection could give great results but the physician must be experienced Juvederm is a great product but I do not use it for lower lids as it looks too full

Amir Moradi, MD
San Diego Facial Plastic Surgeon

A combination procedure works great for tear troughs

Removal of the excess fat is important to a great long term result, but be careful not to over resect it. I like to combine the fat reduction with a fat transfer into the tear trough or line under the eye. The fat transfer can give a very long lasting result and is quite predictable. A fat repositioning procedure has a little higher chance of resulting in lumpiness or incomplete correction. If the correction is incomplete with the fat transfer, you can simply put more in. Juvederm and... more

Shain A. Cuber, MD
Marlboro Plastic Surgeon

Restylane can correct the tear trough and more

Restylane and other HA fillers such as Juvederm are effective in correcting the tear trough and rejuvenating the lower lid without surgery. The application must be done very deeply with skill to obtain a good contour, an injection that your doctor should do rather than a nurse of technician. If the filler is applied too superficially the lower lid puffiness can be accentuated and look like you have a cold, not so good. HA fillers in the lower lid last much longer than in other areas, often... more

Peter E. Johnson, MD
Chicago Plastic Surgeon

Try an injection of Restylane or Perlane first

I would try an injection of Restylane or Perlane first. Juvederm is also a good option. The results are very predictable and the downtime is minimal.

Michael Weinberg, MD
Toronto Plastic Surgeon

And then there is the 3rd Option...

A careful filler injection of Restylane can be very effective with a surprising longevity of greater than 1 year. Personally, I do not like Juvederm for the tear troughs... Lower blepharoplasty with fat repositioning will give you a nice enhancement, too. Recovery is about 12 days. At the end, you may still want a little more volume than you can get from your eyelid fat, though. The 3rd choice would be fat grafting to the tear trough region. About 1.5 to 2cc of your own material will make a nice more

Frank P. Fechner, MD
Worcester Facial Plastic Surgeon

Try Restylane first.

HI! It"s a difficult decision. The results of surgery are long lasting, but you have tricky anatomy (prominent eyes, flat cheek bones), so surgery on your lower eyelids will not be easy, and you will probably also benefit by having a mid face lift (through the mouth). So try Restylane first. VERY SMALL amounts of Restylane need to be injected DEEPLY into the tear trough area, more on the right. What Restylane does here is not so much provide volume; rather it masks the bag by... more

George J. Beraka, MD
Manhattan Plastic Surgeon

Either option is a great choice

You really have two options. 1) fill up the deficient volume with a filler such as Juvederm, Evolence or your own fat or 2) undergo surgery for a lower blepharoplasty to remove or replace the bulging fat or 3) a combination of #1 and #2. The risk with fillers is that they may be visible if injected to superficially or if your body reacts and causes swelling. The risk with surgery is nothing more that any other eyelid surgery. My suggestion would be to have the surgery if you can arrange... more

David Shafer, MD
New York Plastic Surgeon

Understand the end goals!

Let me start by qualifying--not the best photo for assessment, but good enough. I notice the tear trough deformities, yes. I also see hypertrophied orbicularis muscle and early signs of mid-face aging. It appears that the lower lids are a bit low (sclera show), and this is a concern. Fillers are temporary, will not address the muscle, or excess skin. The surgery will produce a long term result, will correct the muscle, excess skin (if any), can correct the low lids and asymmetry. You should... more

Scott E. Kasden, MD
Dallas Plastic Surgeon

Both are effective.

As stated in the previous two answers, both are effective to remedy the hollows in the tear trough area. Restylane is quicker, but temporary. Surgery is much more long-lasting. Reviewing your photos there does appear to be some of the white of your eye showing between the pupil and the lower lid. This may be from the camera being held above your eyes and you are looking up. If you have scleral (white) show when looking straight ahead, you will likely need to have the lower lid tightened... more

Brian J. Lee, MD
Fort Wayne Plastic Surgeon

No eye baggage for the honeymoon

Dear Eyebaghell, The treatment of your tear trough hollowing can be approached in several ways. You have correctly fillers and surgery as the primary choices. Both will effectively correct the hollowing. Fillers will of course offer a shorter duration of correction than surgery. And yes, your midface descent is contributing to the hollowing. The midface can also be elevated with fillers or surgery. So, it really boils down to how long do you want it to last, how invasive you want to be... more

Kenneth R. Francis, MD
Manhattan Plastic Surgeon

Surgery is the best

In looking at your photo, I would do a lower lid blepharoplasty. Although recovery is rapid, you should do the surgery no less than 6-8 weeks before the wedding - best would be to give yourself 3 months for everything to settle down. Usually the lower lids look great after 1 - 2 weeks, but better safe than sorry. Make sure you see a skilled board certified plastic surgeon.