Tear Trough Rejuvenation: Fat Transfer or Fillers?

Question

I'm in my late twenties, have had them for 2 years now. It developed due to prolonged lack of sleep. Considering two options: Either a lasting filler (Restylane seems to be the rave), or an autologous fat transfer. Will an autologous fat transfer hurt? Will it be better than fillers? Will it last?

Behrooz Torkian, MD · Answer

Treatment of the tear trough has become increasingly common in my practice.  My general recommendations on treatments are based mostly on how much volume you need to acheive a good result.  If you can acheive a good result or "fill" of the tear troughs with only a few milliliters of filler, then I would recommend a hyaluronic acid (restylane) filler as the first line of treatment.  You will get results lasting from 12 to 18 months if it is done properly, and the cost is far less than having a fat transfer procedure for such a small amount of volume augmentation.  if you decide you want more long lasting or permanent results, then you may choose to have fat transfer when the filler goes away.

	On the other hand, if you need more volume, for example cheek augmentation and lower eyelid tear trough at the same time, then I would recommend fat grafting as the first line of treatment for you.

	I hope this helps.  You can find before-after pictures of these procedures on my RealSelf profile.

	Dr. Torkian - Lasky Clinic, Beverly Hills.

Michael A. Persky, MD · Answer

Hi,

	Restylane is the only filler that should be used in the delicate and unforgiving lower eyelid area.  Fat transfer in this area is also an option, though it can be less predictable and involve more of a surgical process.  In the hands of an expert, both are good choices.  With Restylane, if you are unhappy or do not like the results, it can be treated with Hyaluronidase injections, or will go away with time (1 to 3 years).  With fat transfer, if there is a lump or bump, it may be permanent and very difficult to correct.  Both processes can be performed without much pain or discomfort, although the recovery from fat transfer is longer.  Good luck and be well, choose your injecting physician most carefully.

	Dr. P

Daryl K. Hoffman, MD · Answer

Juverderm is a safe and reliable treatment for tear duct troughs. In this area, it is quite long lasting. Fat transfer is another option but is a bigger process with longer recovery. Certainly try fillers before fat transplant.

Ron Shelton, MD · Answer

I prefer the hyaluronic acid fillers injected deep to the muscle plane to improve tear troughs. It provides a good improvement for most patients and if there is an unacceptable result, it can be injected by hyaluronidase, whereas fat injections are not easy to remove.

Christopher V. Pelletiere, MD · Answer

I generally have patients try a filler first. It lets you know how much you may need in terms of volume, and whether the correction will work for you or not. If it does not work for you, the Juvaderm or Restylane is not permanent and can be dissolved with Hyaluronidase. If you do like it, then you can do a fat graft once the filler has faded away. This way, you get an idea of how things can look before you go with a more permanent solution.I hope this helps.

Roy A. David, MD · Answer

This is a good question and one that comes up a lot in my office. If I am doing multiple procedures or a full face face fat transfer on a patient, I generally recommend fat transfer to the lower eyelids to correct hollowness. However, if this area is the only concern, it can be hard to justify the time and expense of harvesting fat and injecting, not to mention added recovery, and possibly uncertain results/ possible need for touchup. In these cases restylane can be a quick fix and one year or more of result from a 15 minute procedure is pretty good. Some patients do experience prolonged/ severe edema or swelling from these products, however, so choose an experienced doctor.

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