Implants or Blepharoplasty for Tear Troughs? (photo)

29/F looking for a permanent solution for my under eyes. I have an indentation & thin skin making the area appear dark. I had a consultation with a plastic surgeon and he gave me three options: 1. Temporary filler 2. eyelid surgery with fat grafting 3. custom tear trough implant. I am leaning toward the implant because I've been told the body eventually absorbs the fat because there is no blood supply. I'd appreciate a second opinion on what the right course of action would be. Thanks!

Doctor Answers 16

Fillers probably your safest choice.

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.

Seattle Oculoplastic Surgeon
5.0 out of 5 stars 30 reviews

Fat Grafts for Tear Troughs

Structural fat grafting is a process where fat is deposited droplet bt droplet and the fat will create a blood supply and become permanent. The results can be beautiful and natural. It is important to find a plastic surgeon with expensive experiences and expertise in this area.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 109 reviews


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

Luis Villar, MD, FACS
West Palm Beach Plastic Surgeon
4.7 out of 5 stars 8 reviews

A well-performed injectable filler treatment may improve your lower eyelid grooves.

Based on your photos, you should be cautious before considering any type of lower eyelid surgery. You have scleral show, which means that you can see the white of your eyes between your lower lid margins and irises. Scleral show may worsen with lower blepharoplasty.

You appear to have typical lower eyelid grooves that may be improved by a well-performed injectable filler procedure. You should make sure your doctor is experienced in the delicate art of filling lower eyelid grooves, as this area may be quite unforgiving. My personal experience in this area is with Silikon-1000, an off-label filler for permanent results.

Hope this helps.

Dr. Joseph

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 381 reviews

Tear trough

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.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 24 reviews

Sunken Lower Lid Correction

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.

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 125 reviews

Tear Trough Implants

Tear Trough Implants are old school, but can certainly be used by experienced Cosmetic Surgeons.  However, Mid-Facial procedures, Fat Grafts, Facial Injectables, including Blepharoplasty approaches should be discusses with you.

Robert Shumway, MD
San Diego Facial Plastic Surgeon
5.0 out of 5 stars 11 reviews

Negative vector

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.

J. Smythe Rich, MD
Columbia Facial Plastic Surgeon
4.5 out of 5 stars 20 reviews

Lower Lid Blepharoplasty with Fat Transposition

A transconjunctival lower lid blepharoplasty with fat transposition would be my preferred approach.  While a hyaluronic acid filler like Beletaro Balance, Resteylane or Juvederm my temporarily fill the tear troughs, they never look as natural and certainly do not rival the longevity of surgery.  The surgery only takes about 45 minutes to one hour.  The incision is inside the eyelid where you cannot see it. I have provided a link below to a patient close to you in age.  Happy to see you if you wish in Stoneham or Worcester.

Stuart H. Bentkover, MD
Boston Facial Plastic Surgeon
4.8 out of 5 stars 24 reviews

Blepharoplasty / Tear Troughs

Tear trough implants are rarely used these days. Your best options to correct the loss of volume in the lower eyelids and tear trough region is to use an injectable filler for a temporary result, or fat grafting for a longterm improvement.


Jamil Asaria

FACE Cosmetic Surgery

Toronto, Ontario

Jamil Asaria, MD
Toronto Facial Plastic Surgeon
4.8 out of 5 stars 117 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.