Implants or Blepharoplasty for Tear Troughs? (photo)

It is impossible to say for sure without examining you, but I tend to agree that the irregularity along your tear trough is not prolapsing fat, but rather the contour of your eye socket bone.

Fat grafting can be a very good long term solution [about 50% of the fat will become permanent] but you need a very experience surgeon, as irregularities can occur here with the skin being so thin.

Using fillers are probably your safest bet as they can be reversed easily if you are not happy with the result.

Absolutely do not get tear trough implants.  I know several surgeons who have tried them and learned the hard way that they are a mistake.  I'm also not a fan of fillers.  I recommend if anything removing the excess fat from the lower lids.

The depressions that cast shadows of your lower lids can be improved with implants, fillers or fat preserving blepharoplasty either transconjunctival or incision beneath lash line approaches. Implants were very popular a decade and longer but because of less invasive techniques they have fallen out of favor by the majority of surgeons for tear trough correction. Regarding fillers:. In this area it is very important to have an experienced injector so as not to place the filler too close to the skin. I would recommend trying Jeuvederm or Restylane first as they are not permanent and can be reversed if you do not like the result. If you do like the result, then fat transfer is a good option for a more permanent correction. The blood supply to this area is very good and the survival though differs from person to person has been estimated at 75-85% in this area.

Holding the camera high and looking up at it creates pseudo scleral show and pseudo fat herniation.  We can only give you bad advice with these photos.  A careful hands on examination is essential to give quality advice. Photos should be straight on for general advice.  Best wishes. Knowledge is power.  Luis F. Villar MD FACS

You have scleral show in all of your pics. Being not age related I feel this is anatony of the underlying bones or increasing the positive vector (  like placing a finger over your lower lid.. This would help the progenitor of several problems. I would not do surgery today but rather a shelf of sculptra close to the eye on the bnone and Juvedern neat the rim. Watch the lower lid rise!    In the past transcong fat redistributuion helps and does elevater the lid but not enough there.   I agree tear trough implants are exactly the cure but far too many problems.

 

Good luck

PS you are a bear trap waitiing for most surgeons.