Lower Blepharoplasty for Tear Trough Bags?

Question

I tried fillers for my tear trough bags, and it only made the problem worse! Can a lower blepharoplasty correct this and get rid of the bags?

Anil R. Shah, MD · Answer

The approach to the tear troughs is a complex question and is dictated by the patients individual anatomy and characteristics. Common techniques that are approached by themself or in conjunction include:

Correction with filler (fat, HA) (See below weblink for just filler)
	
		Reposition of fat
	
		Removal of fat lower eyelid

All of the above are extremely technique sensitive and both the choice and application of the technique are surgeon dependent.

William Bruno, MD · Answer

Some patients have a hollowness under their lower eyelids which is commonly termed a tear trough deformity.  This is caused my several different issues, it can be due to excess skin, protruding fat or loss of volume which occurs as we age.  This needs to be correctly diagnosed before a treatment plan can be formulated. Lots of people think that an injectable such as Restylane or Juvederm can simply be injected into this area for correction.  Sometimes that is helpful (in the right candidate), but if there is an excess of fat in the area, an injectable can actually worsen the appearance.  Usually a lower blepharoplasty (lower eyelid surgery) is needed, and not just a simple injection.

	This is an area that a board certified plastic surgeon can help you diagnose and treat, whether it's with a surgical or non-surgical approach.

	Best wishes,

	Dr.Bruno

Vincent N. Zubowicz, MD · Answer

If you indeed have a true tear trough abnormality, there exists a depression in the bone on the side of the nose adjacent to the eyelid.  During a lower lid belpharoplasty, fat from the medial compartment can be position to fill the trough.  This is a permanent fix with fat that is otherwise removed with the eyelid surgery.

	The fact that fillers didn't help makes me question your diagnosis of tear trough abnormality.  Almost always this is a good, but temporary, fix.

Richard Baxter, MD · Answer

The lower lid blepharoplasty is designed to do exactly that: remove the bags, along with tightening up the skin. The trend now is to reposition the fat bulges that cause bags, rather than removing them, for more natural and durable result.
It's a shame that the injections made it worse though, since when done right that can be very successful. Yours may have been placed too high or too superficially. It is important to consider timing too, it may make the most sense to wait until the filler has gone away.

Jeffrey Zwiren, MD · Answer

You would be a candidate for a lower eyelid blepharoplasty. If you have significant bags of the lower lids with lack of soft tissue fullness then these features can be corrected with a lower eyelid blepharoplasty.

Louis W. Apostolakis, MD · Answer

The lower eyelid area is challenging, but results can be very rewarding.  I am sorry that fillers are not working out.  I suspect you had a hyaluronic acid product (Restylane/Juvederm) and would suggest that you have that dissolved using hyaluronidase.  That should at least return your lids to pre-treatment condition.  You could try having a different doctor re-inject them at a later date if you think it was just poor placement the first time.  I recommend using only hyaluronic acid products in the lower eyelids.

	Other more permanent options include surgery utilizing tear-trough implants and fat repositioning.  Some advocate fat injections but the success rate is low and very challenging to reverse if the result is not to your liking.  I have done several hundred of the tear trough implants and have found the reshaping of the eyelid to be very natural, youthful, and permanent.  Complications are very rare and the procedure is relatively simple to reverse in the very unusual event that it is not to your liking.

David C. Mabrie, MD · Answer

Fillers may be placed in the tear troughs when there is a depression in the tear trough. Because each individual's anatomy is a little different, it may take a few attempts and a very skilled injector to treat more challenging cases. Depending on the type of filler placed, you may have the filler dissolved (if it is a hyaluronic acid), you may have to wait for it to be absorbed (if it is Radiesse), or you may simply need more filler placed to complete the improvement. (This is the most common situation.)

Jeremiah P. Tao, MD · Answer

The tear trough depression or "dark circles" are often due to more than one variable. Protruding eye socket fat (above) can make the depression more visible. Also, tissue laxity surrounding a structure called the orbitomalar ligament sometimes contributes to the concavity or sunken appearance. Fillers sometimes are enough, but some people benefit more from surgery including fat repositioning and/or release of the orbitomalar ligament.

Ronald Friedman, MD · Answer

For isolated tear troughs (areas of concavity between the inner portion of the lower eyelid and the cheek), injectable fillers such as Restylane are usually successful.

	For tear troughs associated with lower eyelid bags (bulging fat) and/or skin laxity, lower eyelid surgery is quite reasonable. Techniques vary from surgeon to surgeon, but all entail filling the tear trough with fat.

	I usually elevate the lower lid muscles from the bone at the level of the tear trough and then use fat removed from the lower lids to fill the concavity.

Jacob D. Steiger, MD · Answer

Lower eyelid lifts or blepharoplasty can improve the appearance of the bags under your eyes and the tear trough as well, depending on the technique used.
With modern techniques, there are bascially three methods to treat the lower eyelid bulges:
1) Fat removal - Here the excess  fat is removed. This will not affect the tear trough significantly, although it can in select cases.
2) Fat Hernia Repair - Here the fat is placed back where it came from and the lowereyelid tissues are closed to keep it in place.  This is akin to treating the fat like a hernia repair, and just putting it back into its original position. This rarely affects the tear trough.
3) Fat Repositioning - This is sometimes called fat transposition or septal reset.  Here the fat is repositioned to cover the hollowness beneath the protruding fat. This is your best bet for improving the tear trough.
Make sure you see a surgeon experienced in modern blepharoplasty technques. They will have before and after photos to show you so that you will know what you can expect.

Lower Blepharoplasty for Tear Trough Bags?

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