Will lower blepharoplasty make my tear trough area look deeper? (photos)

I am 47 and i noticed i always look tired. I want an upper blepharoplasty but I am worried about lower blepharoplasty because i have pronounced tear troughs.

Doctor Answers 12

Tear trough treatment options

There are two options to treat your tear troughs. The first is injectable fillers that could last 1 year or more. The second option is to do a blepharoplasty procedure and place your own fat into the tear trough. You are correct that if you have prominent tear troughs and do a lower blepharoplasty alone, this will exacerbate or make worse the appearance of the tear troughs. Our approach is to take the fat where you have it in excess and move it into the tear troughs during the lower blepharoplasty procedure. This accomplishes several things in that it corrects the tear troughs while removing the puffiness in other areas. The other advantage of doing it that way is that it leaves the blood supply to the fat intact and ensures the survival of the fat for many years. Finally, this approach is done without a visible scar to your lower eyelids. Good luck in your area.


Jacksonville Facial Plastic Surgeon
5.0 out of 5 stars 18 reviews

Tear trough outcome after lower eyelid surgery

Thanks for sharing your question. I can appreciate your concern.

In your case there is a possibility to have a great outcome to address your lower eyelids. re positioning your fat and detaching the tear trough and minimal skin removal should do the job. 

Finally, make sure that you have a consultation with a board certified plastic surgeon.

Wishing you the best in your journey

Tear Troughs

If you had a lower blepharoplasty with fat removal it is possible that your tear troughs could look deeper. Tear troughs in lower blepharoplasty can be managed by either fat transposition, injectable fat grafting or tear trough implants. Each method has its own advantages and disadvantages and their indication differs based on what type of lower blepharoplasty is being performed or if it is being done at all.

Eyelid surgery

Hello and thank you for your question. Based on your photograph, you may benefit from a transconjunctival removal or transposition of fat.  If good technique is used, this can be done with no scarring and can result in a natural look, not over-done look, with rejuvenation of your face.  Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results. The most important aspect is to find a surgeon you are comfortable with. I recommend that you seek consultation with a qualified board-certified plastic surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Richard G. Reish, MD
New York Plastic Surgeon
5.0 out of 5 stars 80 reviews

Will lower blepharoplasty make my tear trough area look deeper? (photos)

From your photos it would appear that removing some fat from your lower lids may be beneficial. Often times this can be performed with an incision on the inside of your lower lid so there will be no visible scar. However, to maximally improve your appearance the addition of fat grafts to your tear troughs could be of great benefit as well.  Make sure you see a board certified plastic surgeon with a lot of experience performing these specific procedures.

Will lower blepharoplasty make my tear trough area look deeper?

When there is herniation of the fat pads creating the puffiness look, it's important conservatively remove that fat so that the lid/cheek junction is smoother. For many before and after examples, please see the link and the video below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 129 reviews

Lower lid Blepharoplasty should improve your lower lids!

Dear Patty,

   A lower lid blepharoplasty should improve the appearance of your lower lids significantly.  With time, fat that is usually behind the eye starts to prolapse forward causing a bulge, and at the same time we lose fat in our cheeks and we start to see the hollow of our orbital rims.  So we have a hill next to a valley, and it really stands out...with repositioning of fat, we take some of that fat and move it to where it is hollow to allow things to be even or flush again, with a much improved contour.  Furthermore, if you are just not quite ready for surgery, you can use filler (off-label) in the tear trough to help blend it and that can certainly improve the appearance with results lasting a year or more.  Sometimes it is an option when we are not quite ready for surgery.  Good luck with your decision and let me know if I can help! 

Jasmine Mohadjer, MD
Tampa Oculoplastic Surgeon
5.0 out of 5 stars 2 reviews

Lower lid blephs and tear trough

I agree with other doctors who replied.  I think that your tear troughs look worse next to the bulge of your prolapsed orbital fat of your lower eyelids.  A transconjunctival lower bleph with fat repositioning to fill out the tear trough further will yield the best results for you.   Good luck! 

Lawrence Kass, MD
Saint Petersburg Oculoplastic Surgeon
4.9 out of 5 stars 116 reviews

How Will Lower Lid Blepharoplasty Affect the Tear Trough?

As others have stated, every Surgeon will have a slight variation on how he/she will perform your procedure. In my opinion, the photos show orbital fat pseudoherniation with mid-facial descent which makes the eyelid-cheek junction more prominent.  The lower lid blepharoplasty I typically employ for these findings involves a SOOF (Sub Orbicularis Oculi Fat pad) lift and judicious removal or orbital fat.  A properly performed SOOF lift involves release of the orbicularis retaining ligament which allows for raising the cheek. Because the blink reflex is mediated medially in the region of the tear trough, this area must often be filled. 

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.8 out of 5 stars 82 reviews

Lower eyelid blepharoplasty for tear troughs

A lower eyelid blepharoplasty would improve the appearance of your under eye area by reducing the "bulge" caused by the fat pockets underneath the eyes.  If these fat pockets are re-positioned into the area directly underneath them, it would result in a smoother appearance of the under eye area.   

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.