Tear Trough Injections. Any Alternatives?

Generally, under eye fillers are amazing in the hands of a very experienced injector.  However, there is value for many in using an eye concealer product.  This products essentially reflect light making the lower eyelid area appear less dark-photoshop in a bottle.

Extended lower blepharoplasty with release of the attachments between the bone and skin with cheek or midface lift will eliminate the tear trough. You can see before and after photos on my page here on Real Self. The link below is to my article published in the journal Plastic and Reconstructive Surgery on this technique.

The tear trough can be treated with fillers, with fat and release of soft tissue attachments that create the depression.

Tear trough filler alternatives are tear trough implants or fat transfer. Implants provide permanent correction, but there is a chance of asymmetry and infection. Fat transfer is sort of similar to fillers, also requires injections in the area; the results may be permanent, but this is fairly subjective.

While often done, injection of fillers into the the tear troughs is not without risk.  It is off label and several side effects or complications can occur: irregularities, swelling, bruising and the product showing through the skin or reflecting the light to look blue (called Tyndall affect).  Blockage of a small blood vessel with the material can lead to loss of skin and even blindness.

The more accepted treatment for tear troughs is a lower lid blepharoplasty with movement of protruding fat of the lower lids into the tear trough.  This is a lower eyelid blepharoplasty with fat transposition.  This can be done through the inside of the eyelid, transconjunctival.  I have attached a link to some photos this procedure.