Should I do tear trough filler or lower bleph? (Photo)

Question

41 year old with volume loss and some fat pads showing. I realize it fairly minor and surgery comes with risks like lid retraction. I have been evaluated by a facial plastic surgeon who described my under eyes as fairly tight and too minor for surgery but a second opinion surgeon said I'm a good candidate for trans conj bleph and fat pad re-draping to fill in volume loss. Is filler less risky?

Anna Chacon, MD, FAAD · Answer

Deciding between tear trough filler and lower blepharoplasty involves considering both the extent of your concerns and your comfort with potential risks and outcomes. Here are some factors to consider for each option:

Tear Trough Filler:
Benefits: Non-surgical, minimal downtime, and immediate results. Filler can effectively address minor volume loss and provide a subtle improvement.
Risks: Although generally safe, fillers can cause temporary side effects such as swelling, bruising, or, in rare cases, vascular complications.
Longevity: Results are temporary, typically lasting 6-18 months, depending on the type of filler used.

Lower Blepharoplasty:
Benefits: Offers a more permanent solution for both volume loss and fat pad protrusion. Surgery can provide a more dramatic and long-lasting improvement.
Risks: As with any surgery, there are risks, including lid retraction, scarring, and infection. Recovery time is longer compared to fillers.
Suitability: Given your concerns about minor volume loss and tight under-eye skin, it's crucial to weigh the potential benefits against the risks. The second opinion suggesting you are a good candidate indicates that surgical intervention could address both volume loss and fat pad issues effectively.

Considering your situation, if your primary concern is minor volume loss and you're wary of surgical risks, starting with fillers might be a prudent approach. They allow you to evaluate the aesthetic improvements without committing to surgery. However, if you desire a more comprehensive and lasting solution and are comfortable with the surgical risks, a lower blepharoplasty could be appropriate.

Ultimately, the decision should be based on your personal comfort with the risks, desired outcomes, and discussions with trusted medical professionals who have evaluated your specific case.

John Michael Thomassen, MD · Answer

A lower lid transconjunctival blepharoplasty will remove the bulging fat pads and give you a smooth lower lid with no scars.  Fat grafting to camouflage is less reliable.

Eric M. Joseph, MD · Answer

Transconjunctival lower blepharoplasty is the surgical removal of under eye bulging fat pads through an incision on the inside of the lower eyelid. Based on your photos, you may indeed be a good candidate for this, however, an examination would be necessary. I hope this helps! Sincerely, Dr. Joseph

Anil R. Shah, MD · Answer

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin in Winnetka and Chicago. This is a great question. Yes, using filler for volume loss under the eyes generally carries fewer risks compared to surgical options like transconjunctival blepharoplasty. While fillers can provide a more immediate and less invasive solution to restore volume and improve the appearance of under-eye hollows, it’s important to choose a skilled injector who understands the delicate area around the eyes. Fillers can effectively smooth out minor volume loss without the risks associated with surgery, such as lid retraction or longer recovery times. However, the results are temporary, typically lasting from 6 months to 2 years, depending on the type of filler used. If you’re seeking a non-surgical option with minimal downtime, fillers could be a suitable choice for your concerns. I hope this helps and best of luck!

Jeffrey H. Spiegel, MD · Answer

Tear trough fillers are reversible and we inject hyaluronic acid fillers in the area which keeps the area beautifully hydrated for years. If you're young and your skin is nice and tight (as what I'm seeing from your photos) I would try tear trough fillers first and do the bleph later if you still need it. Good luck from Boston!

Chet Mays, MD · Answer

Thank you for your inquiry! By your photos, you're a great candidate for either a lower bleph with fat transfer to your tear trough which is a more permanent solution or filler to your tear trough to help fill the hollowness which would be a temporary solution. It depends if you would want a surgical or non-surgical solution as well. We would love to meet with you in person to discuss your options in depth. Schedule a consultation with a Board-Certified Plastic Surgeon like myself to help you reach your goals and create a plan.

Michael A. Persky, MD · Answer

Hello there RP,
It really depends if you are ready to undergo surgery.  You would be a good candidate for a transconjunctival fat transposition blepharoplasty.  It is a complex operation that should only be performed by an expert surgeon, so if you go that route, choose your surgeon very carefully!  On the other hand, the best filler material to use under your eyes is your own blood products, albumin and PRF which are 100% natural without anything added.  When combined, an injectable gel is formed that is safe and effective.  The procedure involves drawing two tubes of your blood, processing them in the office, and then injecting the gel with a cannula under the eyes.  The advantage of traditional filler in this delicate and unforgiving area is that it is 100% natural and there is no possibility of immediate or delayed malar edema (swelling) around the eyes.  Feel free to contact our office with any further concerns or questions.  Good luck and be well.

Nelson Lee Novick, MD · Answer

A nonsurgical HA filler approach would seem perfectly reasonable alternative to surgery. The proper injection technique employing a robust HA volumizing filler for the cheeks can not only help to contour a more ideal, desirable, oval, heart-shaped face (a feminine Ogee Curve), but help to smooth and make more gradual the transition between the upper cheeks and the lower lids (thereby improving the under-eye hollows, bags and tear troughs). 
You would be wise to consult with an experienced, board certified cosmetic dermatologist filler expert. In experienced hands, treatment typically takes about fifteen minutes, yields immediate results, and engenders little to no significant downtime. Hope this helps and best of luck.

Camille Cash, MD · Answer

You have several options to address the under eye area.  Fillers can provide an improvement in the contour, but are temporary.  AccuTite is a minimally invasive procedure that is safe for this delicate area.  It uses RF technology to stimulate collagen production giving longer lasting results.  It can be combined with fillers for a more complete look.  A lower blepharoplasty is the surgical option to remove skin and address contour concerns.

Narin Adem, MD · Answer

Placing filler in the tear trough would not be the best option for your case. Anatomically as we age our ligaments loose, this might cause filler migration and unnatural results. If, however you would like to try hyaluronic acid fillers, there is an option for placing the filler in the deep medical cheek pad, it would give support to the orbit and make the under-eyes appear less prominent.Second option would a treatment with polynucleotides, like Nucleofill, however you should keep on mind, that although we have obtained good results with polynucleotides, they are NOT FDA approved, and might not me available in every medical aesthetic providers office. Another option would be to stimulate the under eye area with PDLA, which helps restore the youthful appearance of the delicate under-eye area. It is reasonable to try also CO2 laser treatment to tighten the area. For the best results consult with an expert in your area. Hope it helps. Best regards - dr Adem.

Should I do tear trough filler or lower bleph? (Photo)

Answers (13)

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