Tear trough deformity? Or fat? (Photo)

Question

Hi! I’m 27 and currently live in Japan. My under eyes have bothered me for a long time. Since my teens, I’ve had what I don’t really know what to call other than “bags” under my eyes. Here in Japan, a popular procedure for people who have issues with their under eyes is having fat removed, but I actually don’t know if what I have is fat, a tear trough deformity, or something else entirely. Wary of fillers and fat graft because of the potential for lumpiness, but unsure how to address the issue.

C. Blake Perry, MD · Answer

My recommendation would be lower lid blepharoplasty with fat repositioning. This would involve an incision on the back of the lid (transconjunctival) and taking your natural fat and using it to fill your tear trough. This would remove the “bag” under the eye but also volumize your tear trough. Best to see an eyelid expert.

William Portuese, MD · Answer

You have herniated fat in the lower eyelids which can be removed through a trans conjunctival approach with two small incisions made on the inside of the lower lids. Since you're only 27, a conservative amount of fat would be removed.

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