I had a deep plain facelift, eyebrow lift, and upper bleph with fat transfer - Can my tear trough area be improved? (Photo)

You need a lower blepharoplasty to allow the fat to roll into the tear trough to conceal it.

Best Wishes,

Gary Horndeski, M.D.

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin - Winnetka & Chicago. This is a great question. Yes, even after a deep plane facelift, brow lift, upper blepharoplasty, and fat transfer, tear troughs can sometimes look uneven, hollow, or shadowed if the initial volume placement wasn’t fully balanced or if some fat resorption occurred. Improvement is possible, but it requires a careful, conservative approach since the area has already been surgically altered. Options include small amounts of hyaluronic acid filler to subtly smooth hollows and correct shadows, or in some cases, micro-fat grafting revision if your own tissue is preferred.

Thank you for your question and the photo provided.
I think you may actually have two separate things going on that is contributing to the appearance of a prominent tear trough. The first is that you have a slight amount of tissue deficit/hollowing at the tear trough region. This could be improved with a formal lower blepharopalsty with fat transposition vs another fat transfer to the tear trough. Additionally, your tear trough has the appearance that it continues down onto the cheek which could be an early festoon or malar bag. This can be a slightly more challenging issue to fix, but in my opinion could be improved with a small amount of fat transfer to the cheeks in addition to a deeper laser resurfacing to address the festoon/malar bag.
I hope this helps and best of luck!Kyle Kimura, MD

It's hard to see much in this one limited photograph, however, it does look like you can benefit from additional volume to the cheeks. This could be done with further fat grafting, a cheek implant, and possibly other approaches.

YES, your lower eyelids and the visible bilateral (both right and left sides) oblique linear shadow across your malar eminence (cheek prominence) can be resolved. An office procedure to lift lateral lower lid superficial lamella or a more formal lower blepharoplasty with cheeklift and canthopexy are possible solutions. If you're disinclined for more surgery, skillful application of low G prime hyaluronic acid filler may also work well.

At least from the photo provided, an appropriate HA filler in the hands of an expert, board certified cosmetic dermatologist filler expert, can improve the remaining tear trough without adding any bulk to the adjacent cheek. In experienced hands, this procedure should take no more than about fifteen minutes to perform with immediate, on-the-spot results and little to no significant downtime. Hope this helps and best of luck.

Based on the one post, a photo of the tear trough can be improved by a combination of the Endo, laser and nano fat grafting or H a fillers. Best of a virtual concert with expect fees to arrange from $2000-$3500.