Should I Have Blepharoplasty or Fillers on Tear Trough? (photo)

I want to get rid of my tear troughs and am trying to decide b/w lower blepharoplasty (tran conjunctival) or fillers. I've had a lot of mixed opinions and am just so desperate now to understand what I should do, I am only 25. Some people told me that the fat removal wont solve my problem.... I am trying to understand if my tear troughs are caused by the fat or lackness of fat tissue beneath the skin? Please see photos

Doctor Answers 12

How Does One Treat A Tear Trough Defect At Age 25?

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At 25 years old, I would certainly consider fillers first to see how natural they look and whether they correct the defect.  On you, the defect or tear trough appears to be formed by binding down of your skin to the inferior medial orbital rim accentuated by lower eyelid fat.  If the fillers don't give you the result you are looking for, then I recommend a lower eyelid bleph with repositioning of lower eyelid fat over the medial orbital rim with concurrent release of bands holding this skin down to the orbital rim creating the apparent tear troughs.  A transconjunctival fat removal would not cure the problem, and may in fact, accentuate it.  

All that being said, I feel you should see a Board Certified plastic surgeon for a face to face evaluation with recommendations. 

A Graduated Approach To The Tear Trough Is Usually Best

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An HA filler (Restylane is probably the best choice) would probably be the best first option. It will likely give you the result you want without surgery. A small amount (1 syringe) is all that would be needed. If you like the result, simply have it re-done every 9-12 months. If it doesn't quite do what you want (or if you like the results but want a more permanent answer), then a transconjunctival belpharoplasty, removing only fat would be the right next step (no visible scar and very long lasting results). Sometimes going slow is best. Good luck.

Michael R. Menachof, MD
Greenwood Village Facial Plastic Surgeon
4.4 out of 5 stars 27 reviews

Tear Trough options

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Thanks for your photos.  The transconjunctival fat removal will not work for your situation, and may actually make it worse.  From your photos, I see a separation of the fat pads of the eyelid, medial, and lateral malar regions defined by the orbitocutaneous ligaments.  Fillers may be a simple and cost effective method to camoflage the contours you wish to hide, but resetting the support structures can only be done surgically for a longer term result.  Hope this helps in your quest for smoother contours.

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Tear troughs

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Tear troughs are usually formed by soft tissue deficits in the medial aspect of the lower lid-cheek junction. It may be accentuated by fat pockets,edema( swelling), soft tissue adherence, as well as shadowing. Sometimes release of the attachments in that are improve the depression, and sometimes fillers can camouflage this area. It is always best to be seen in person for proper evaluation.

Blepharoplasty vs. Fillers

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I do see that you have some depression in the tear trough area.  Since you are still quite young, a quick and easy treatment would be to have a filler, like Restylane, injected into tear trough.  It should be placed very deep, and sit right above the bone.  I like Restylane because it tends to give more fullness then other fillers and doesn't require a big commitment on the patient's part.  The filler will generally last about 6-9 months and there is a product call Hyalouronidase that can dissolve the product if you are not satisfied with the result. You could consider Blepharoplasty or Blepharoplasty with fat transfer later on down the line.

A HA filler or microfat grafting will treat the dark circles

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Dear lady,

the dark circles under your eyes are mainly caused by a lack of soft tissue over the bone in that area. This causes a shadow, which is most visible in daylight. The best option in your case is to fill up this groove. 

There are two good options :

  • an injection with a good brand of Hyaluronic Acid, which will usually last at least a year
  • you have a more permanent correction with microfat grafting (a form of lipofilling)

Either treatment is good, if performed by an experienced surgeon. In our center (Gent, Belgium) we perform these treatments since years. If you want you can check our website


Alexis Verpaele, MD
Belgium Plastic Surgeon

Dark circle treatment

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The two best options in your case are either filler injection or lower blepharoplasty with fat transposition (where the existing fat is moved to lower position to fill the hollow area or dark circle).  Either option can work great.  The decision may rest on if you want a nonsurgical nonpermanet treatment versus surgical permanent treatment.  See an oculoplastic surgeon.

Treating tear trough with filler or blepharoplasty

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From looking at your photos it suspect that using in office fillers (such as restylane) would be a good way to go to help efface your tear trough area. Removing fat would tend to just hollow out your lower lid area. A longer term option would be fat grafting. You can check out my link below to learn more about tear trough treatment.

Should I Have Blepharoplasty or Fillers on Tear Trough? (photo)

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Try very low amounts of Restylane to the trough areas in a few weekly visits to see if the improvement is to your liking. Otherwise a transcend. or open lower lid bleph. might be the more aggressive answer. 

How to fix lower eyelid shadows? (photos)

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In agreement with other responders, at age 25, your skin is taut and you're trying to transform an area of shadow that absorbs light (tear trough) into an area that reflects light.  Filler is first choice, can always have surgery if this doesn't do it.  Can use hyaluronic acid gel, totally reversible, if you're uncertain or anxious about the result.

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.