Tear trough deformity - what to consider? (Photo)

You do not have a tear trough deformity. That is the area transitioning between thick cheek skin and thin eyelid skin. You have moderate herniated fat bags in the lower lids creating the puffy look. A trans conjunctival conservative fat removal of the herniated fat bags in the lower lids can be accomplished to improve your look. This procedure performed under brief general anesthesia and outpatient procedure

Most things related to facial aesthetics are strongly correlated with underlying bone structure.
This is especially true for issues seen on young people.
For those who have insufficient projection of the maxilla, we often see what appears to be a loss of volume in the mid face with bulging of the lower eyelid fat pad.
All of the treatment options you mentioned are viable.
Even choosing from one procedure over the other is probably not as important as finding the right provider.
There are advantages and disadvantages to all procedures, including the use of fillers.
Fillers have an amazing advantage in that the results are temporary and if you’re not happy with the outcome, you simply just have to wait.
If you’re unhappy with the outcome of permanent surgery, then you’re in a bit of a pickle and this could have far greater implications.
Transfer is probably the most unpredictable, even though it may seem very appealing by its very nature.
Many people view fat transfer as a permanent version of fillers which it is not.
Fat transfer is by its very nature, unpredictable, imprecise, and unforgiving if patients don’t like the outcome.
Implants have lost favor overtime because of advancements in available fillers and procedures.
If you can find plastic surgeons who have a lot of experience with implants that it could be an option for you.
The key is always to find someone who’s really good at what they do.
Mid facelift Has some real strong point advantages, but also downfall.
The drawback to the procedure is that the recovery is really tough and patients are often swollen for months afterwards.
When done correctly, the procedure can give amazing results.
Before giving up on the idea of fillers, I suggest you take a look at the website of Dr. David Mabrie MD in San Francisco.
Real self will not allow me to include an outside website link so you’ll have to Google his name.
David is a facial plastic surgeon whose practice is devoted exclusively to facial augmentation using fillers.
He has an incredible collection of before, and after pictures on his website.
His work is the best I’ve ever seen.
it can be helpful to simply have an understanding of what can be accomplished using only fillers in the hands of the right provider.
I’m not suggesting everybody fly to San Francisco twice a year to get fillers by David.
I do think it is important to recognize what’s possible and what the gold standard is so you can compare this to what other providers in your community are able to accomplish.
Once you know what quality works look like you know what to look for before and after pictures when consulting with providers in your community.
This is true for any procedure.
To find the right provider exclusively on in person consultations, avoiding virtual consultations.
Bring pictures of yourself taken properly the same way plastic surgeons take before and after pictures.
Pictures should not be cropped the way yours are and should show with the full face.
Use those pictures as reference whenever reviewing before and after pictures.
During each in person consultation, ask each provider to open up their portfolio and show you their entire collection of before, and after pictures of previous patients who had similar facial characteristics to your own for whatever procedure they recommend.
Highly experienced providers should have access to hundreds or preferably thousands of before and after pictures.
This is the best way to get an understanding of how much skill and experience the provider you’re communicating with has and what your results are likely to look like.
If the provider does not have an impressive collection of before and after pictures, then that should be a big red flag and tell you to have Another consultation with another provider.
The provider may require consulting with quite a few plastic surgeons.
I think having four or five consultations seems reasonable, considering procedures that are permanent and irreversible.
This becomes especially true when the situation at hand is complex and not easily treated which I think is the case for midface volume augmentation.
All of the treatment options are viable and in the end, choosing which procedure is best for you needs to be done with a provider.
Focus on finding the best provider and everything else will fall into place.
This may take some time and require a significant amount of time and effort.
The biggest mistake I see patients make is trying to vet providers, using their phone or computer and scheduling only one consultation before having surgery.
By scheduling only one consultation patients are more or less eliminating the ability to choose a better provider.
I don’t think you can properly leave at providers without meeting them in person.
Surgeons are ultimately responsible for the surgical outcome, but patients are responsible for provider selection.
Provider selection is in my opinion, the most important variable and were all the effort should be focused.
Best,
Mats Hagstrom MD