Tear trough fillers issues - Are tear trough fillers unpredictable? Would a lower bleph be a better option?

Question

I have had consultations with a few doctors who have all said that they are no longer doing tear trough fillers due to the mixed results. One said that they look ok the first time they are done but more and more patients are experiencing issues with persistent treatments. Can I ask for opinions on this. Instead it was recommended that I have a lower bleph which I'm told would be more predictable in terms of results and would give me a good 10 years of improvement before possibly having to treat again.

Camille Cash, MD · Answer

Under eye fillers can produce very nice results if the patient is a good candidate and the filler is placed by an experienced injector.  A lower blepharoplasty can also produce very nice results and is more permanent but is a surgical option.  I've included a video that I hope you find helpful.

Anna Chacon, MD, FAAD · Answer

Tear trough fillers can indeed be unpredictable, especially in the delicate under-eye area where skin is thin and prone to fluid retention. Many providers are becoming more selective with their use due to several reasons:

Variable Results: Some patients respond well to fillers, while others experience issues such as puffiness, swelling, Tyndall effect (a bluish tint from superficial filler placement), or irregularities that can be hard to correct.

Cumulative Effects: With repeated treatments, filler may migrate or create a puffy, unnatural appearance over time—even if it initially looked good.

Anatomy Matters: Not all tear troughs are good candidates for fillers. If there’s significant fat prolapse (eye bags) or skin laxity, fillers may worsen the appearance or not offer much improvement.

On the other hand, lower blepharoplasty (lower eyelid surgery) is often more predictable and long-lasting—especially in patients with herniated fat pads or significant skin redundancy. It directly addresses structural issues (like excess skin or fat) and typically offers a smoother contour and refreshed appearance. Results can last for 10 years or more, and surgical refinement is often easier to manage than complications from overfilling.

In summary:

Fillers: Non-invasive, immediate, but best for early, mild volume loss and hollowing.

Blepharoplasty: Surgical, more downtime, but offers a more definitive and predictable result in the right patient.

Choosing between the two depends on your anatomy, goals, and tolerance for risk and recovery. A thorough evaluation with a board-certified dermatologist or oculoplastic surgeon is key to determining the best approach for you.

Kishen Nara, MBBS, FACCSM(Surg) · Answer

Thank you for your question. It is a hard one. The tear trough region is known to be a difficult area to treat. An experienced aesthetic practitioner would not only understand the varied aesthetic treatments available but also the diversity of genetic composition of patients. Underlying medical conditions may predispose patients to develop a certain presentation of the tear trough. The tear trough region in itself is complex with its lacrimal system, venous drainage and thin skin to name a few. Orbital skeletal resorption makes it more complicated with varying angular anatomical changes of the tear trough in time.
Specific to your question, dermal filler and lower blepharoplasty cannot be equated. They are two different treatment modalities. Dermal fillers, or non-surgical treatment, may address structural visual changes to the tear troughs. Lower blepharoplasty or surgical cosmetic procedures may not necessarily address visual changes to the tear troughs. There are advantages and disadvantages for each respective treatment. 
I cannot see any imaging provided. Even so, it is imperative to gain a comprehensive consultation with a medical practitioner trained in aesthetic surgery and medicine to give you better insight into your enquiry. 
Pleas view some examples of blepharoplasty surgery with its changes to the tear trough presentation. 
I hope this give you some perspective into your question.
Disclaimer: The answer provided does not constitute medical advice. It is imperative to seek a consultation with a medial practitioner who has training specific in cosmetic medicine and surgery.

Harold J. Kaplan, MD · Answer

Hello.  You need to post photos to be able to provide feedback. Without the photos it is difficult to say which option would be more beneficial.  Most surgeons do not offer tear trough injection goons because it’s hard to do well consistently and takes a lot of time to get good at.  Check the utl below.

Leonard Grossman, MD · Answer

The doctors you have seen are absolutely correct, fillers, as a rule create more problems when used in treating tear troughs. Blepharoplasty however, will also not help you with a tear trough 99% of the time. The best way to correct the tear trough is with the use of fat grafting. In the right hands, fat grafting produces natural and permanent results but only if this Plastic Surgeon has a lot of experience in fat grafting techniques. I hope this helps and good luck from Leonard Grossman MD, organic Plastic Surgery, NYC.

Tear trough fillers issues - Are tear trough fillers unpredictable? Would a lower bleph be a better option?

Answers (5)

Answer: Photos Needed

Answer: Photos Needed

Answer: Treating tear troughs

Answer: Treating tear troughs

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Tear trough fillers issues - Are tear trough fillers unpredictable? Would a lower bleph be a better option?

Answers (5)

Answer: Photos Needed

Answer: Photos Needed

Answer: Treating tear troughs

Answer: Treating tear troughs

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Recommended reading

Everything you need to know about Dermal Fillers

Our mission is to create a world where every investment in modern beauty is Worth It.