Fillers or Blepharoplasty on my Tear Trough?

I am not sure whether fillers or blepharoplasty would solve my problem. I am 29 years-old, i have always had a little puffiness around the eyes (probably due to water retention and allergies) and now i have these terrible tear throughs under my eyes, which make the puffiness look worse. Thank you very much in advance!

Doctor Answers 24

Fillers for tear trough

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This can be a difficult problem.  At your age I would recommend against a blepharoplasty mostly because in 3-5 years you will be faced with the same problem again. Fillers on the other hand are easy and can be done as needed over the years. The problem with fillers is a matter of must be done by someone with experience and good results or it can show

Fillers or blepharoplasty for tear troughs

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The puffiness around the eyes is best treated with a lower transconjunctival blepharoplasty. We do no recommend fillers around the eyes because we have seen numerous problems with it including long-term puffiness over several years duration and does not go away unless specifically treated or have it removed.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 157 reviews

Tear trough

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As a first non permanent option I would try the fillers using Restylane.  The small amount of fat displacement and herniation could be addressed surgically should it become more obvious with age. As with any surgery this comes with risk, be it small.

Lee Kleiman, MD
Annapolis Facial Plastic Surgeon

Fillers would be a good option for treating the eyes

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From the pictures, it would appear that you have some puffiness due to movement of fat as well as some hollowing along the tear trough.  It does not look like either is too significant but, due to their proximity, they can both look worse than they actually are.  I don't think surgery would be the wrong approach but I would opt for a filler as you are young and the puffiness is not very severe.  I think all of the fillers work very well in the tear trough.  Although my personal preference is Radiesse, you should talk with a physician who is experienced with fillers in this area and go with the one with which they are most comfortable.

Jonathan Sonne, MD
Naples Facial Plastic Surgeon

Correction of tear trough

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Both lower blepharoplasty and fillers such as fat or hyaluronic acid may be used to correct prominent tear troughs, which you seem to have. The procedures carry different risks and offer different results, and are not mutually exclusive. You should consult with a board certified plastic or oculoplastic surgeon to review all options before proceeding. 

Olivia Hutchinson, MD
New York Plastic Surgeon

Eye bag treatment for tear-trough hollow: Eyelid #plasticsurgery or Injection

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Hi 8422anon in Germany, 

As other plastic surgeons have stated, both are good options for appropriate candidates. Plastic surgery of the eyelids is generally reserved for older individuals, while injections are better options for younger patients. If you choose cosmetic surgery, then only conservative eye fat would be removed through an incision on the inside eyelid. Office injections of hyaluronic acid (Restylane or Juvederm) can help reduce the bags, but are not FDA approved in these areas. Lastly, allergies & hormonal conditions can greatly affect eye, cheek, and facial appearance so those should be addressed first before plastic surgery. After a comprehensive evaluation by a plastic surgeon can he/she help determine appropriate options for you. Best of luck.

Dr. C

Houtan Chaboki, MD
Washington DC Facial Plastic Surgeon
4.9 out of 5 stars 89 reviews

Either would solve your problem

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Dear Anon,

Either procedure would/could correct your tear trough hollowing.  Fillers are obviously less invasive and carry a lower risk.  None of them are FDA approved for filling the tear trough however and if you accept that fact you could proceed with them.  With your history of allergies expect some significant swelling and possibly even severe bruising even with fillers.  At your age, it is difficult to recommend blepharoplasty, but only you can decide what works best for you.  Good luck!

Restylane or Blepharoplasty for Lower Eyelid Hollows?

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Hello in Germany,

Restylane used conservatively and properly placed in your lower eye lid hollows would be best for you.  Choose your injecting physician most carefully.  Good luck and be well.

Dr. P

Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 39 reviews

Tear torugh treatment

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Probably the best thing for you would be a little filler in the tear trough.  You do have a bit of herniated fat as well.

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

Very subtle issue.

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Filler with Restylane is probably your best option.  You will need about 1 ml under each eye.  This service will last about a year or more.  Lower eyelid surgery should be limited to transconjunctival lower blepharoplasty with arcus marginalis release to place the lower eyelid fat at the top of the cheek.  However in 5 to 10 years your under eye hollows will reoccur and again filler will be the option.  Avoid overaggressive surgery if at all possible.

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

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.