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

Fat Grafts for Tear Troughs

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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.

Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 123 reviews

Fillers probably your safest choice.

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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.

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 42 reviews

Blepharoplasty / Tear Troughs

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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 139 reviews

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

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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 435 reviews

Tear trough

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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 29 reviews

Sunken Lower Lid Correction

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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.


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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
4.4 out of 5 stars 11 reviews

Tear Trough Implants

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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 12 reviews

Placing a tear trough implant will be a huge mistake.

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Depending on how the implant is placed it could be a total disaster.  The tear through implant was great when introduced 25 years ago.  It was all we really had to augment the hollow under the eye.  It was a helpful method.  However, it was less than ideal.  The implant when placed through the mouth was associated with implant infections and nerve damage.  The implant was somewhat replace with midface lifting methods.  However, what really replaced this method is hylauronic acid fillers.  Yes these need to be topped off every 1 to 2 years.  But this is an office service.  If there is a lump or bump, it is easily adjustable.  It is important for you to understand that there is no permanent here.  I have not examined you but I am impressed how thin your lower eyelid is.  This increases the risk that the implant contour will be visible through the skin.  The bump in the lower eyelid that surgeons here would like to remove as fat is actually your orbital rim.  You can confirm this by putting your finger on this bump.  If it is hard, it is the orbital rim, not fat.  You are also not well informed to think that grafted fat will disappear.  No the problem with grafted fat is that it can be lumpy especially in a thin eyelid and require surgery to fix.  I would encourage you to think about fillers and try them out.  Finally, who does the service is very important.  Not all injectors are the same.  You are asking for your face to be sculpted so you need a fussy artist to do this.  Hope this information helps.

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

Tear trough deformity in young woman with small amount of fat.

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Tear trough deformity in young woman with small amount of fat is best handled by transconjunctival blepharoplasty with fat repositioning. BUT you could try as I do with my patients putting saline or numbing liquid in the trough first. That way if  you like it you can wait for surgery and just have filler.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 38 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.