Desperate to Solve my Tear Trough Problem? (photo)

Ive gotten so many mixed opinions on my tear troughs that am now more CONFUSED than ever before. Some have said deep plane midface lift, some Resylane, some say absolutely not, blepharoplasty. etc I am 25. The first photo is me at 21 and I am happy with that look. The smartest thing to ask now is not what procedure I should get done, but to understand THE CAUSE of my puffiness/ & tear trough in the hopes of getting clarity. Any doctor recommendations for AUSTRALIA would be very helpful. Thanku.

Doctor Answers 5

Tear trough problem

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While I cannot tell what has caused the puffiness in your particular case, I can tell you some of the reasons that cause it.  Sometimes lower eyelid puffiness can be due to genetic causes, and if so, it can commonly occur when people are in their 20's.  Sometimes it can be due to aging.  As the layer that holds the fat under the eye weakens with age in some people, the fat bulges out more.  Allergies can also play a role.  

As far as advice on how to improve it, I would say there are two options.  One is to have a hyaluronic acid filler (Restylane, Juvederm, Belotero) injected into the depression below the puffiness to help with the appearance.  The other would be to have lower eyelid surgery to remove or reposition some of the fat.  The injection would be easier but temporary, while the surgery would be more involved but last much longer.  

San Francisco Facial Plastic Surgeon
4.5 out of 5 stars 18 reviews

Puffiness in lower lids

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The puffiness in the lower lids is caused by herniation of the 3 orbital fat compartments on the lower lids.  Tranconjunctival lower blepharoplasty with the incisions on the inside and a conservative amount of fat removal is all that is required.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Undereye Bags / Line

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The first thing I would recommend you try is an injectable like Restylane, specifically for the line that goes from the inner corner of your eye down toward your cheek bone. After that, you can consider other options like blepharoplasty if you're still unhappy.

Cameron Rokhsar, MD, FAAD
New York Dermatologic Surgeon

Treatment Options For Lower Eyelid Puffiness

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The reason that you feel you look worse is that you have protruding fat bags of your lower eyelids. Because the fat bags are not yet severe, Restylane injected into the tear trough area can make the fat bags appear less prominent even though they will not go away. Restylane injected into the tear trough typically lasts 1 to 11/2 years. The surgical option is transconjunctival lower lid blepharoplasty to remove the fat bags with external incisions or scars.

Anita Mandal, MD
Palm Beach Facial Plastic Surgeon

Transconjunctival blepharoplasty with fat repositioning

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Most young patients with your problem have family genetics to "thank" for the eyelid fat prolapse. It is your natural anatomy. Now, there are certain factors that could exacerbate the problem, i.e. allergies, thyroid disease, etc.


You would be an ideal candidate for either a transconjunctival blepharoplasty with fat repositioning, OR fillers such as Restylane or Juvederm. As mentioned by others, the former is more expensive, but a longterm solution, whereas the later is a quick fix but needs to be repeated yearly [give or take].


Good luck.

p.s.Dr. Raf Gabriel, Dr. Sullivan, or Dr Dinesh are excellent oculoplastic surgeons in Australia, but we have some excellent ones right here in town as well.

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