Blepharoplasty or tear trough implants? (photo)

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?

Doctor Answers 9

Tear Trough Solutions

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
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.



Fillers or lower lid blepharoplasty or both options.

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

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.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.8 out of 5 stars 41 reviews

Tear trough fillers

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

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

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Blepharoplasty or implant?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

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.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Lower Blepharoplasty with Rim/Tear Trough Implants

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

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. 

Blepharoplasty or improving tear trough ?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

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. 

You are overeducating yourself into a disaster.

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

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.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Blepharoplasty, tear trough implants

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

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.

Fillers or lower eyelid surgery

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Thank you for asking about treatment of your lower lids.

  • Your photo suggests prominence of the lower lid fat.
  • If it has appeared as an adult, I suggest external lower lid surgery with arcus marginalis release of the fat to fill the tear trough.
  • A transconjunctival blepharoplasty works well when fat has always been present.
  • Skin treatment with tretinoin and a TCA peel helps hyperpigmentation.
  • I use tear trough fillers if surgery isn't an option. Results are less predictable.
  • I only do fat transfers under the lids surgically.
  • I avoid synthetic implants, lasers and office fat injections near the eye when possible for safety. Hope this helps. Best wishes.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.