Fillers or Bleph for my Tear Troughs?

My tear troughs are starting to make me self-conscience. I have barely gotten enough courage to consider filler. I don't know if I could see myself having a blepharoplasty since its surgery (and I'm worried about not looking like myself). 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. What would you recommend?

Doctor Answers 12

Fillers vs. lower eyelid surgery.

In your case, fillers.  You're too young for surgery.  Skins too tight.  No bags.  No surgery.

The tear trough can be very consistent in the right hands.  Go to a facial plastic or oculoplastic surgeon.

Restylane is great, should last you about a year in that area.  If there is an issue with it you can melt it with an enzyme.

Artefill would be more permanent but it can not be melted if there is an issue or if (very rare) it were to become infected.

Best of luck

Chase Lay, MD

Bay Area Facial Plastic Surgeon
4.9 out of 5 stars 75 reviews

Fillers for tear troughs

Fillers are the best option for you and can have dramatic immediate results. Surgery can make your lower lids more hollow.  I would use only Restylane for the tear troughs. See an oculoplastic surgeon.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 72 reviews

Fillers or Bleph for my Tear Troughs?

 In your particular case, from the photos...fillers seem to be a better option for filling the tear troughs.  The right eye does not show lower eyelid fat bags, while the left has marginal ones.  This means Blepharoplasty or Eyelid Surgery will not accomplish much and would most like make the tear troughs more noticeable.  It is ture that placing fillers in the tear troughs can be problematic causing bruising, swellg and lumpiness if one of the thicker fillers are used (Radiesse or Perlane) whcih they should not, IMHO.  IMO, you have 3 choices.

  1. Do nothing but in that case , nothing changes.
  2. Try some Restylane or Juvederm to see how you like it and how long it lasts
  3. Try some fillers like Perlane to shape and augment the Cheek that will make your more attractive and take attention away from the tear trough area.  More reliable area for fillers and IMO easier to maintain the results.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 24 reviews

Fillers would be an excellant choice for you.

Thank you for the photo.  It looks like it would be premature to do any lower eyelid surgery on you, but some filling agent would add volume to your tear trough and smooth the present contour.  There are a number of filling agent options but I always start with Restylane as it is the least expensive and lasts the shortest amount of time.  Therefore, if you like the results, you can move to a longer lasting filler, albeit at a slightly higher price.  If you don't like the results, there is a shorter time till they disappear, or you can have it dissolved and the cost has been minimized.  Contact a board certified plastic surgeon who is proficient with tear trough injections and discuss this in detail.

Jeffrey M. Darrow, MD
Boston Plastic Surgeon
5.0 out of 5 stars 98 reviews

Tear troughs treated with fillers or blepharoplasty

From the photo, it does not appear that a blepharoplasty would be of any benefit to you, however a hyaluronic acid filler to the tear troughs could give you a great result. You might also benefit from a filler to the cheek area.  I personally have many years of experience with HA fillers in the tear troughs, and some of my patients have experienced long lasting results upwards of 8 years at this point.  This area can be challenging, so you should definitely seek out someone in your area with a great deal of experience.  Best of luck.

Corey S. Maas, MD
San Francisco Facial Plastic Surgeon
4.5 out of 5 stars 13 reviews

Filler or surgery for tear troughs

Either surgery or filler (i.e. hyaluranic acid, especially Juvederm) work well to correct the tear troughs if performed correctly. Find someone experienced in these procedures in your area.

Donna Rich, MD
Houston Plastic Surgeon
4.5 out of 5 stars 33 reviews

Tear trought options

Hi Azguy.  A filler to your tear troughs should give you an excellent.  Find some one who has done a few.  Your best option for an initial filler material is one of  the hyaluronic acid products such as juvederm or restylane.  If you don't like the result, you can have it reversed.  Other options include fat grafting (by an experienced plastic surgeon) of the use of some of the longer lasting fillers.  I do not see the need for you to consider a blepharoplasty.  Good luck!

Joseph N. Togba, MD
Oakland Plastic Surgeon
4.6 out of 5 stars 17 reviews

Fillers for tear troughs

From your photo it appears that you would be a great candidate for fillers to the tear troughs.  I don't feel that the results are usually inconsistant - I've performed this on many patients who have been extremely pleased with their result.  Many of my patients who are on TV love this because it really helps with the shadow that is visible on camera especially with the extreme lighting.  I'd recommend you keep searching for facial plastic surgeons in your area to find someone who feels comfortable performing this - I'm sure you'll find one you feel comfortable with.


Best of luck!

Dr. Begovic

Catherine Huang-Begovic, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 32 reviews

You may try fillers first

Please send a picture with the room light and without camera flash. You have depression over the lower lid and filler can give you improvement.  You can reverse the fillers if you are not happy with the result.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.8 out of 5 stars 122 reviews

Fillers take away that tired look

I appreciate your concern and may have a different approach to solving this tear trough issue.  As the face ages the upper cheeks lose their volume creating a longer, drawn appearance, thus the tear trough region gets tagged.  Relifting the upper/mid face helps to resolves much of this concern.  This may be done surgically or via facial fillers. 

John W. Bass, MD
Phoenix Plastic Surgeon
4.0 out of 5 stars 8 reviews

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