Lower Blepharoplasty for Tear Trough Bags?

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.
 

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

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.