Tear troughs - would a lower blepharoplasty improve the appearance of my eyes? (Photo)

Although filler treatment for tear trough deformity is commonly performed, I am not sure you want to consider this for the next 30 - 40 years.  If I am correct, you are 40 now, and do demonstrate some signs of mid face descent  I would recommend you consider some type of procedure that would elevate the lid cheek  junction and tighten the suspensory ligaments of the lower eye lid.  Adding a small amount of fat with this  procedure would be helpful as well. 

Thank you so much for your pictures. I agree with your surgeon that evaluated you 12 years ago you do not appear to have excess skin or fat. You have some deficiency in your cheek volume which gives you a prominent tear trough. Either a cheek implants or volumizing fillers like VOLUMA® or RADIUSES® can be helpful.

The tear troughs can be filled out with an injectable filler to reduce their sagging and hollow appearance. I’ve had great results with Teosyal Redensity II, which is approved in Canada for the tear troughs.

Circles under the eye are generally caused by multiple
factors.First, the sack or septum of
the lower lid begins to loosen and the front part of the fat that sits around
the eye starts to protrude forward.This
tends to never go below the boney rim of one’s eye.Secondly, the tear trough area where tears
run down ones face) deepen.So, the step
–offs are greater from the lash line down to the cheek.Also, as the cheek falls it pulls on the eye
complex exaggerating the contour problem.
Treatments include removing the bag (Lower Lid
Blepharoplasty) and lifting the tear trough with filler or fat grafting.Each procedure is good alone and together
they are even better.
Darkness around the eye is a different issue and can be due
to skin thickness and how close blood vessels are to the eye.Usually it is genetic.I never guarantee improvement in skin
darkness with the above procedures but sometimes they do help.
Find someone you trust whose before and after photos you
admire and speak with them further about these issues.Good luck!

It is certainly possible to improve the lower eyes with either filler which is short term or a blepharplasty which is long lasting. Both are safe and effective treatments.regardsDr J

That does not necessarily mean that it can't be done.  As my father liked to say: "When the butcher tells you the meat is bad, you should listen."  You have a thin lower eyelid/cheek junction.  You do not have herniated orbital fat.  If you put your finger on the area that looks full, what you are feeling is your bony orbital rim.  Can this be treated with micro fat grafting?  The answer is only if you want to be crippled by the results of surgery.  Unfortunately there is almost no tissue coverage so the graft fat and the scaring it will cause can't hide in plain slight.  The same is really true with hyaluronic acid fillers.  The difference is that the filler can be easily adjusted without having to return to the operating room.  Also the hyaluronic acid filler can be adjusted.  You will have a challenging mid face/lower eyelid to treated.  Do not look for the least expensive store front for your injector.  You will need the best under eye injector you can find and paying extra money for their expertise is well worth it.  In my opinion, Restylane is the only product for this area.  I would stay away from the so-called smooth fillers like Juvederm and Belotero.  Properly done, this service will last well over a year.  Less is more.

Just a little filler can help you greatly. If someone knows how to inject yuor lower eyelids, they can really help you. They need to use cannula and not needle. 

The tear trough under your eyes caused by depressions in the
area can be permanently corrected with surgery or temporarily camouflaged with
fillers. Surgery would require a fat-repositioning lower lid
blepharoplasty. In this surgical
procedure, fat from the eye area is moved into the tear trough depression
filling the depression.

There are great non-surgical option to fill in
under eye depressions and hollowness. Using dermal fillers, a liquid
eyelift can be performed. Dermal filler
such as Restylane would be placed in the cheek and tear trough to hide the
depression or bag underneath your eye.

Many times patients will try the non-surgical
option first to see if they are happy with the result. If they do not get
the results that are seeking, they can still undergo surgery. Other
patients want a permanent solution and choose to undergo surgery.

At times, patients will have a darkening of the skin in this
region. This staining of the skin can be
difficult to treat and will not improve with either a liquid eyelift or a lower
blepharoplasty.

Each of these choices are viable options.
I would carefully review the pros and cons of each procedure and decided
what would be best for you.

Thanks for your question.The photos are somewhat restricted but give us some information. You would still need a consult with a PS before you proceed.Having said the above I think that you may benefit from tear trough filler. This is relatively easily done in expert hands. There are several fillers that work well in this area and they seem to last longer than other places. I use a cannula for added safety.

You look like you would do well with some restylane under your eyes in your tear trough.  This would smooth things over and prevent the need for surgery.  Be well and good luck.