I Am 30 and Had Tear Trough Implants. Thought They Would Eventually Go Away, But Haven't? (photo)

Dear Kami, Your tear trough implant placed 4 years ago has apparently only partially corrected your tear trough defect.  At this stage, I would leave implant in place, go in through a lower eyelid incision, go down to the inferior medial orbital rim, release the tissue attached to that area, open the medial inferior fat compartment, do a fat slide over to the orbital rim, and tack the fat under the released ligaments.  This procedure was first described by a South American plastic surgeon, Dr. Lobe. 

You need to find a Board Certified plastic surgeon experienced in eyelid surgery with specific experience in reconstructive techniques.  The procedure should take about 1 hour, stitches out in 3 days, and bruising and swelling gone by about 8 days.  Don't give up hope.  There is a solution to your problem.

I think your best are an injectable filler or fat grafting from elsewhere. I do not think you have sufficient bulging fat into the eyelid to allow lasting coverage of the trough with that fat.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

I would recommend fat grafting to the tear trough. You can try filler first and if you liked the result, get fat injection.

Injectables are a good alternative to any further surgical procedures. Even fat transposition is probably not more predictably effective than fat  or other injectable fillers. Injectable fillers, other than fat, are readily and safely injected, with little if any downtime (2-7d max.),  in experiences hands..  My choice of fillers would ne hyaluronic acid (Restylane, Juvederm, Bolotero, etc,) which are essentially all equivalently effective. They last about 1 year = or -. Radiesse is longer lasting 1-2 years+ but a bit more expensive.  I appears that the Implants you have, are positioed well, and don't need to be removed or replaced.  Because changes continure to take place, over a period of yeears, there is nothing permanent that won't need to be augmented or altered with the passage of time.  Good luck in your persuit of happiness.

If the implants were not completely effective for eliminating the tear troughs, then you have three options. The first and simplest would be to have fat injections on top of your existing implants. The second option would be to replace the existing implants with larger ones to get a fuller effect. The third option would be to do an infraorbital fat transposition over the existing implants. There are advanatages and disadvantages to either approach and more information, such as what type of implants you have in place, would be needed to help you make an informed decision.