I Am Unhappy with my Tear Trough Deformity and I'm Relatively Young Only 33. I'm Considering a Tear Trough Implant? (photo)

I'm a licensed esthetician and I see clients on a regular basis and many do not seem to have the condition to the degree I have it at my age (I notice in older clients mostly). I noticed over the last two years due to stress and weight loss that this problem developed My lines are deep and prominent. I notice filler tends to have a better result when the skin is thicker or the tear trough is not as deep. I need to rebuild structure and form as filler only fills but still leaves a flat appearance

Doctor Answers 8

Tear-Trough Implant

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I looked at your photos and you do appear to be a good candidate for the tear-trough implants.  I very much like the results produced by the implants and do a great number of them.  When sized and adjusted properly, they produce a result that can't be distinguished from a natural tear-trough-free lower eyelid.  Be sure to also have the fat pads re-draped during the procedure for the best result.

You are right to say that injectable fillers are limited.  Certainly Restylane can produce improvement in a tear-trough but for more pronounced cases it just can't achieve the goal.  Soft tissue fillers in general are hampered by their mobility and risk of bulging during smiling when used in larger quantities.  The implant can be thought of as an adjustment to the shape of the bone, not the soft tissue so it does not bulge with facial expression. 

I Am Unhappy with my Tear Trough Deformity and I'm Relatively Young Only 33. I'm Considering a Tear Trough Implant?

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Posted photos are very poor to review for your issue of the trough deformity. especially if thinking about an implant. Fillers done correctly will improve and there is NO surgery involved. Reconsider. 

Treatment of the tear trough

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I disagree with your premise that filler tends to have a better result when the skin is thicker or the tear trough is not as deep. In fact appropriate fillers placed appropriately tend to rejuvenate and thicken the overlying skin. Your best bet is to try a temporary filler before jumping to the placement of an implant.


I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon

Tear Trough Deformities May Be Improved By Volumizing The Cheek Immediately Below

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While some tear trough deformities require direct injection of filler right into the trough itself, others respond well to volumizing the cheek area immediately below the trough itself. From the photos provided it is very difficult to assess the problem.

In general terms, however, we often find some degree of flattening of the upper inner cheek area (even in young people in their late twenties and thirties) directly under the trough itself. This area serves as a support for the trough, without which, the lower lid widens and the trough becomes more prominent. In such cases, the installation of a volumizing filler, such as Juvederm UltraPlus XC, directly into the flattened area of cheek immediately below trough can support the area sufficiently to diminish the width of the trough and lower lid in general. Once injected, the material can be molded up into place to soften or obliterate the tear trough. It is important to seek out the services of an injector experienced in treating this area, since this is not a simple case of injecting a wrinkle.

Tear trough deformity

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I suggest you try the filler first.  You can achieve nearly as much with filler that you could with implant with less risk of complications and asymmetry. You can definitely create a shape with filler, although this may require more than one session.

Tear trough and lower lid

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It is difficult to see your main concerns from the photos.  I suggest going for a consultation.  If it is a true tear trough issue, then filler may be beneficial as long as it is judiciously administered.  Good luck.

Fillers are currently the best treatment for tear trough deformities.

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Fillers are going to give superior results for tear trough deformities for the following reasons:

  1. Fillers may be formed to exactly the shape of the tear trough
  2. Fillers may also be placed in the cheek bone area which is usually necessary.
  3. Fillers may be modified as you age.
  4. Very small changes can be made with fillers.
  5. Less risk, less down-time with fillers.

My favorite filler for the tear trough is Restylane although this will vary between practitioners.


Good luck in your search for information!

Evaluation for Tear Trough Implants or Fillers

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I perform tear trough implant surgery in my practice in New York. Tear trough implants may still not be the best option, as in my experience, a shallow tear trough is often associated with a loss in cheek volume (particularly with weight loss). In terms of rebuilding structure, I think you’re on the right track. In my practice, I have improved the tear trough area with combinations of platelet rich plasma, hyaluronic acid in conjunction with volume enhancement of the cheek (or submalar) area with a submalar implant or filler such as Radiesse. As an aesthetician, I would ask you to evaluate your eyes in the context of the rest of your face before moving forward with a tear trough implant.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.