filler or blepharoplasty for my tear trough?

My deep tear troughs are starting to really make me self-conscience.  I have been reading the pros and cons of each and am not sure what would be better.  I have barely gotten enough courage to consider a filler but I hear that they are difficult in this area to work properly.  I don't know if I could see myself having a blepharoplasty since its surgery (and I'm worried about not looking like myself once its done).  The fillers seem to be easy but everybody says to find an "experienced" person.  I talked to one board certified plastic surgeon who performs fillers but won't do them in the tear trough area because the results are so inconsistant.  Also, it appears that there are several different kinds of fillers as well.  Based on my photo, what would be recommended? 

Doctor Answers 18

Restylane and other fillers for tear trough area

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It is interesting to read the answers from multiple physicians. It just goes to show that there is no single approach to your issue and the issue of tear trough in general. 

If you go to different doctors, their answer will depend on their aesthetic evaluation of your situation (some think you don't have a problem, some think it is a huge deal), on their experience with the possible solution (have they done a lot of fillers? Or many surgical blepharoplasties?), and on their assessment of their own success (some think that they do a fabulous job, but in reality it is quite sub par).

I do a lot of under eye fillers. I also do a lot of blepharoplasty procedures. You do not need blepharoplasty. You have no fat or skin to remove and no fat to re-position. You would, however, benefit form a filler injection. Restylane by far is the best and the safest choice. You need someone who does a lot of these, and who has good natural results. It is in fact a very difficult injection. It may take several injections spaced two to four weeks to get the best results. I would appreciate the honesty of the providers who admit they are not good at it. 

Find someone who is excellent. 

Good luck,

Dr. Stella

Seattle Facial Plastic Surgeon

Restylane injections to tear troughs work very well.

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 From your picture, I would say that you are a much better candidate for fillers than for surgery.  The issue is that these injections have to be done just right.  You inject tiny amounts of Restylane, deeply, right against the bone and under the muscle.  The results can be excellent and last three years.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Tear Trough Filler

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I think you could get a great result with fillers put into the tear trough region in the right hands.  This would be a conservative way to start.  If you are then looking for something more permanent, you could explore having a lower blepharoplasty / fat repositioning at that point. 

Kimberly Lee, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 13 reviews

Oculoplastic surgeons are more likely to offer this type of service.

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You are doing the right thing to search for an injector who offers this service.  Experience really does matter here.  If the surgeon say that they do not do the service, please do not make them do the service.  

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

Filler for tear trough area

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I would recommend that you see another board certified plastic surgeon or dermatologist who is an experienced injector. I think you would benefit from Restylane in the tear troughs and have not personally found the results of such injections to be inconsistent.

Treatment options for the tear trough

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Thank you for your question and photograph.  It does not appear from your photograph that you have an excessive amount of fat above the tear trough so your best option would be to correct the tear trough depression using a filler such as Restylane.

Donald M. Brown, MD (retired)
San Francisco Plastic Surgeon

Tear Trough Procedure

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Excellent feedback from panel members.  As many have stated, you will likely see much benefit with Restylane to this area.  I recommend consulting with several injectors in this area and selecting the provider you are most comfortable with.  A practiced injector can show you photos of their work and honestly evaluate your needs.  

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.4 out of 5 stars 7 reviews

Restylane for the Tear Trough

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Thank you for the photos.  You would be a good candidate for filler injection into the area.  I would not recommend surgery for you as it would not address the problem.  You have hollowing in the tear trough area, which a HA filler like restlylane would work very well.

Most board certified plastic surgeons would and do perform this procedure on a regular basis, so I would look around for such.  It is not a very difficult area to inject but you do need to find someone that does have experience with this area, as it can be somewhat tricky.

Good luck.

Farbod Esmailian, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 88 reviews

Restlyane works very well in the tear trough

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I certainly agree with the previous reviews.  After reviewing your photo, I am guessing surgery would be premature at this point.  I would recommend a hyaluronic acid filler for this area.  I use all varieties of these products but find that restlyane is the most reliable and affords great surgeon control in the tear trough.  This is a very safe product I have been using for many years in the tear trough (although this is an off-label application).  If by chance, you were uncomfortable with the result (which is unlikely) you can adjust this product as needed after your injection with massage and hyaluronidase.  That can be very reassuring for most first-time patients.

Lower eyelid surgery with fat repositioning (see Hamra fat transposition) is highly successful but should only be contemplated when non-surgical methods will not provide adequate results.

I hope that is helpful to you.

Todd Christopher Hobgood, MD
Phoenix Facial Plastic Surgeon
4.9 out of 5 stars 57 reviews

Fillers for the tear trough

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Based on your photo, I would start with Fillers. However, even in experienced hands, the outcomes can be variable. Sometimes, people need more than the physician puts in and needs a touch up. I recently had a woman who I treated six months ago and she was thrilled with her results. I recently did the same treatment with Restylane in the same place with the same amount and she wasnt happy. It turned out that she just needed some more product. I put a little more in and she was thrilled.

Find someone that is experienced and knows where to place the product (under the muscle and on top of the bone) and if there is an issue, give him or her the oppotunity to discuss it so that you can get the outcome that you want.

Kenneth Beer, MD
Palm Beach Dermatologic Surgeon

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.