Tear troughs at 25: should I get infraorbital implants or cheek lift? (photos)

Question

Hello, I am 25 years old and have noticeable tear troughs. I have always had these since I was a child. My question is should I have infraorbital implants or mid face/cheek lift to alleviate the appearance. No suggestions for fillers. I want something permanent. Thank you.

Nelson Lee Novick, MD · Answer

Of course, it is understandable that one might jump to more aggressive, invasive surgical techniques for treating tear troughs. The idea that these might yield permanent results is alluring, but not reality. True and implant does not change with time, but the skull, muscles and surrounding fat do change significantly with time. So, what might look nice immediately after surgery, may not look so five years or ten down the road when the above changes occur--possibly necessitating removal of the implant or additional surgery. For decades already, fillers of all types (most recently a host of HA fillers) have proven effective for treating tear troughs and yielding immediate results with little to no significant downtime. Make sure, however, to consult with a board certified cosmetic dermatologist and ask to see his/her personal befores and afters prior to agreeing to proceed. Best of luck.

Jonathan Kulbersh, MD · Answer

Thank you for your question and photos. Since you’re not interested in fillers, cheek augmentation with implants may be a suitable option for you. Implants can increase the projection of the cheekbones, thus improving the appearance of the eyes. 
Though implants can provide a permanent change, silicone options can be easily removed in the future if desired. I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon who can assess your concerns and cosmetic goals and help you decide on the best approach.

Jason Emer, MD · Answer

Fillers like Belotero, Volbella, and Restylane Silk are good for improving under the eyes, but keep in mind that a combination approach will give the most improvement. My patients try to get non-surgical treatments to avoid surgery, so we use fillers, lasers, microneedling/PRP and stem cells. I suggest consulting with an expert to develop a treatment plan best suited for you. Best, Dr. Emer​​​​

Barry L. Eppley, MD, DMD · Answer

A cheeklift is not a procedure that will necessarily improve or eliminate tear troughs. Tear troughs require volume where that is done by injectable fillers, lower lid fat transposition, fat injections or tear trough implants can be debated. Each has their merits and advocates but you are correct in that the only assured permanent solution is implant augmentation of the infraorbital rim.

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