Blepharoplasty or tear trough implants? (photo)

Question

In addition to a rhinoseptoplasty and chin implant, I am looking into filling in the orbital concavity and addressing the hyperpigmentation. What would be the best options here based on my pics?: Non-surgical non-invasive trough fillers (i.e. Radiesse, Restylane or Juviderm) or autologous fat grafting? Upper/lower blepharoplasty? Transconjunctival blepharoplasty - laser for greater control and accuracy? Transconjunctival arcus marginalis release? Orbital rim/tear trough implants?

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

Although your photos are helpful and exam by a board certified specialist with extensive experience in eyelid surgery is needed for the best opinion. Fillers and Fat transfer (long lasting) are excellent for most with tear trough depressions, so much so that they are now used far more often than implants. You have great questions - but perhaps the most important one is: how do I find the most experienced surgeon. See below link to assist you in this quest. #BestBlepharoplastySurgeon#TearTroughCorrection

Vincent N. Zubowicz, MD · Answer

Fillers are safe but temporary and probably are good place to start. The case can be made for lower lid blepharoplasty using the periorbital fat to fix the tear trough abnormality and add volume to the upper cheek.

Kenneth D. Steinsapir, MD · Answer

Please don't wreck yourself with surgery.  That is exactly where you are headed.  Your desired after picture shows a minimal rhinoplasty result that can be achieved with minimal manipulation of the nose.  A septoplasty is not needed.  Do you need a septoplasty for breathing issue?  If that is the case, I recommend seeing a functional nasal surgeon for this procedure alone and not trying to get your health insurance to pay for a cosmetic surgery.  Inappropriate septoplasty has the potential to profoundly change the way the nose looks.

	Regarding the under eye hollow, tear trough implants are essentially obsolete.  They have been effectively replaced with the hyaluronic acid filler Restylane.  Jevederm, Radiesse and grafted fat are not an appropriate products for the undereye area.  You appear to lack herniated orbital fat so you are not a candidate for an arcus marginalis release surgery.  I recommend that you actually stop researching so much on the internet and consider getting to actual consultations.  Please be careful out there.

Steven Wallach, MD · Answer

In my opinion fillers are often a better option than tear trough implants. Fillers are a nice way to camouflage the area.

Curtis Wong, MD · Answer

I strongly prefer natural and your lower lids appear to have prominent fat pads that when transferred across the rim, will smooth your lids out quite nicely. If it wasn't enough, then you can consider fat grafting or dermal fillers (temporary) or the implant then.

Barry L. Eppley, MD, DMD · Answer

The most predictable and largest correction is going to come from orbital rim/tear trough implants combined with a pinch or small amount of lower eyelid skin removal. Since you would need a transcutaneous lower blepharoplasty anyway for an arcus release and fat transposition, it is just as easy to place permanent volume with implants. The hyperpigmentation of the lower lids is a secondary issue to be addressed after surgery with either peels, fractional laser resurfacing or BBL treatments combined with topical bleaching agents.

Fereydoon S. Mahjouri, MD · Answer

Since you do not have too much of skin laxity in your lower eyelid, you are a candidate for either lower blepharoplasty with release of arcus marginalis and transposition of fat or correction of tear trough with fat transplantiorn or injection of juvoderm ultraplus. Dark circles aroud your eyelids could improve by light laser, IPL , or topical application of bleaching creams.

Thomas A. Narsete, MD (retired) · Answer

It is hard to answer your question from the photos so I will do the best I can. In my past, I have only performed blepharoplasty if there is enough fat and skin ptosis.Looking at your picture, you have a ring appearance to the lower lid with some lowering of the lid/cheek junction. A fat fill here can be effective and may need to be repeated. The advantage here is you have not burned a bridge and you can have the blepharoplasty at a later time. I would not consider a tear trough implant for you.All the best.

Blepharoplasty or tear trough implants? (photo)

Answers (8)

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