What are the chances/percentage of people needing fillers for tear trough after lower blephoroplasty? (Photo)

I have puffy under eyes and the surgeon I am planning on going to suggested transconjunctival rather than outer sutures. When asked if I would have the hollow look some older people have he somewhat brushed it off saying it could be filled. I don't want to have to have fillers done after my surgery if it can be avoided. Is there any way to tell if a patient will be pre disposed to this problem before the blephoroplasty is done?

Doctor Answers 8

Blepharoplasty planning

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  • From either approach, the lower lid fat can be repositioned as well as trimmed,
  • Trimming the fat only risks a hollow eye; repositioning the fat risks excess fullness
  • Discuss your options with your surgeon,It is best to avoid the need for tear trough fillers when possible.
  • Your photo suggests descent of cheek tissues. A mid-face or face lift may also be needed for the best possible result. Best wishes.

Need fillers for tear trough after lower blephoroplasty?

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Hello and thank you for your question.

As a general rule, having a lower lid does not lead to you needing fillers unless your Plastic Surgeon is removing the fat. In my practice, like that of many Plastic Surgeons, we tend not to remove the fat, just tighten the sagging of the lower lid area that sent you to the Plastic Surgeon in the first place.

Some patients will land up with filler because they need the filler to assist with their loss of volume, which occurs, for most people, with ageing.

Sometimes, once the lower lid sagging has been tightened(without removal of fat), the loss of volume component is still there, because that has not been treated by the surgery.

An experienced Plastic Surgeon can usually guide you.

Tear Trough and Lower Lid Bleph

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Most eyelid surgeons nowadays will, rather than simply resecting the fat that has herniated out, reposition that fat into the tear trough hollow to efface that depression. There is some unpredictably in how that will turn out, so one can't say with 100% certainty that you won't need a little touch-up with fillers or fat injection down the road.  I imagine you will require a small skin pinch as well.  My experience has been that a skin-muscle flap approach (with outer sutures, rather than through the inside of the lid) does a wonderful job of effacing that trough, in the right patient.  

Best of luck!

Dr. Alexander

Ashlin Alexander, MD
Toronto Facial Plastic Surgeon
5.0 out of 5 stars 48 reviews

Fillers for tear trough after lower blephoroplasty

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Dear Renee
You have excess fat in the eyelid and a hollow below these fat bulges.
There is a tough Ligament that separates these 2 areas that enhances this appearance.
You don't need to have Surgery to remove the fat AND have fillers after the surgery to fill the deficit.
Your Surgeon should be able to release this ligament and re drape the bulging fat into the tear trough, any residual hollowness can be touched either with small amounts of fillers or using fat performed at the time of your surgery.
Hope this helps

Fat removal and lower lid bleph

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Fat removal is indicated with herniated fat but it also can be used to re-drape.  Filler can be used also to soften the lower lid cheek junction.  You may also need s skin pinch as well to remove excess skin. If so, I almost also do a canthopexy to support the lower lid. Good luck.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Hollow after lower lid bleph

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The best way to avoid hollowing is to preserve the fat and reposition it into tear trough.  This is usually done with a transconj. approach.  However you need to ask your surgeon if they do this type of surgery, as many surgeons just take out the fat.  If after fat repositioning you are a little hollow, then you can fill with either an HA filler or fat.    

John J. Martin, Jr., MD
Coral Gables Oculoplastic Surgeon
5.0 out of 5 stars 31 reviews

Hollowing after blepharoplasty

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You are justified in your concerns about hollowing after blepharoplasty. The logic is simple. Fat removal has been traditional in blepharoplasty, both upper and lower. Eventually most people develop fat atrophy as they age. If you have had a blepharoplasty in the past with fat excision, you will have a deficit (hollowness) in your later years. All too often we do operations and pat ourselves in the back, but give little thought to the longevity of our results. I don't routinely take out fat in every blepharoplasty anymore, and when I do, it is only as much as necessary and no more. One very elegant option for you is to reposition the fat over the inferior orbital rim. This takes care of two problems. It reduces the volume of the fat pocket and it softens the tear trough

Ben Lee, MD - Account Suspended
Denver Plastic Surgeon

Lower lid blepharoplasty

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The amount of tear trough left after a transconjunctival lower lid blepharoplasty with fat transposition can vary.  Yes, you might think you need some filler also, but you cannot tell until the fat moved into the tear trough heals in place.  No way to predict completely.  I have attached an example.  

Stuart H. Bentkover, MD
Boston Facial Plastic Surgeon

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