Question About Tear Troughs

Hi Dr Yang
Would a mid face and lower bleph surgery greatly improve tear troughs or is filler the only solution?
Thanks in advance.

Hi RoseAbbey,
Would a mid face and lower bleph surgery greatly improve tear troughs or is filler the only solution?

I would not say that there is only one solution for the tear trough problem.

Depending on the surgeon’s technique, lifting the midface or cheek along with lower eyelid surgery may be able to improve the tear trough area; however, the surgeon will need to be aware that there is a deficiency of volume in the tear trough area, and if the patient have too much lower eyelid fat, the surgeon can use a fat repositioning procedure along with the midface/cheek lift to blend the lower eyelid and cheek area.

The possibility of improvement with this technique needs to be considered on a case by case basis. If the person has a flat cheek with visible loss of volume of the cheek, along with no apparent excess of lower eyelid fat bulging, yet still has deep tear troughs, then I find it highly unlikely for that particular person to get an improvement in the tear troughs using the midface/cheek lift and lower eyelid surgery. What will may the tear trough area thicker? There isn’t enough lower eyelid fat to reposition, and the cheek fat is already deficient.

If the person has enough fat on the cheeks and lower eyelids are bulging with fat, then adding additional fat to this person may make them look too puffy (or if small amounts of fat or fillers were placed in the right places, it can still look okay.) In this person, trying to reposition the existing fat is more likely to be successful.

Hopefully with the examples given you will understand that the techniques can work, but work best in certain types of patients. Not all procedures will give the perfect or equivalent results to another procedure. Hopefully the plastic surgeon is recommending the right types of procedures for the right patients, and using one standard procedure on every patient that comes through the door.


Dr. Yang