35, female, filler or lower bleph for these hollows/tear troughs? (Photos)

Question

Hi, I’m 35 year old female with aging under eyes. Wondering if a lower bleph or tear trough filler is better solution for these hollows/tear troughs I hate.

C. Blake Perry, MD · Answer

You are a great candidate for lower lid surgery with fat repositioning or fat grafting. This surgery utilizes an incision on the back of the lid and moves around your natural fat to fill the tear trough. Additional CO2 laser would help tighten the skin and improve fine line and wrinkles. Best to see an eyelid expert.

Lexie Wang, MD · Answer

Hi lovesu. The main reason that you are starting to see tear troughs based on these photos is due to bone loss of the socket that holds the eye in. The goal with camouflaging the tear troughs is adding back some type of volume to the area where volume has been lost. This can be accomplished with either filler or fat grafting or possibly even a midface lift (can't tell because your photos are truncated). What is "better" is truly in the eye of the beholder- obviously filler injection doesn't involve "surgery", although many people are now noticing more and more the risks related to undereye filler. A surgeon will likely always tell you fat grafting is safer but you will have to do your due diligence with consultation. If you decide to go the filler route, I would make sure you are going to a very experienced injector.

Harold J. Kaplan, MD · Answer

Hello lovesu22.  You are a better candidate for dermal fillers than blepharoplasty.  This type of surgery works best for patients that have excess skin under the eyes.  You can have surgery to remove some of the protruding fat but that would still leave you hollow, just smoother.  Surgically, we do not recommend fat grafting under the eyes.  With dermal fillers under the eyes (link below), you should be able to get good results from s skilled injector.  best of luck.

Gary M. Horndeski, MD · Answer

A lower blepharoplasty can be used to transfer the fat from the orbit to the area below to fill it out or use nano fat injections as they are more permanent than fillers.

Best Wishes,

Gary Horndeski, M.D.

Mats Hagstrom, MD (license on probation) · Answer

The lower eyelid, mid phase transition zone is complex and with typical facial aging. There are two variables that tend to happen.
In the youthful face, the lower eyelid should be tight and snug area just below this in the upper mid phase should be plump and full.
With facial aging, we get the opposite. In the older face, we see fullness in the lower eyelids with the loss of volume just below in the upper mid face.
To make a good assassin, it helps to understand which one of these two is primary secondary.
In your case, I don’t think the bulging of the fat pads in your lower eyelid, and they think well done the fillers can go along way.
To get an idea of what can be accomplished using only facial fillers, I suggest checking out the website of Dr. David Mabry, MD in San Francisco. I’m not suggesting people travel to San Francisco to get fillers, but he has a lot of before and after pictures on his website and to me his work is some of the best I’ve ever seen. Sometimes having a reference or gold standard to know what is possible when it comes to assessing the work of other providers can be helpful.
Fillers offer a lot of good advantages, including being accurate, predictable, and forgiving if you don’t like the outcome.
Best,
Mats Hagstrom, MD

35, female, filler or lower bleph for these hollows/tear troughs? (Photos)

Answers (5)

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