Tear Trough Implant

Q: Dr. Eppley, I am interested in a tear trough implant. I had a four lid blepharoplasty performed ten years ago followed by an inappropriate injection of Radiesse to both lower lids. Granulomas subsequently developed and were excised a year later but this left me with a depression and mild ptosis of the right lower eyelid. I have had this lower eyelid depression treated with hyaluronic acid fillers for years by a dermatologist, but the depression needs more stable support, especially as I age. I am Interested in consulting with you due to your extensive experience with facial implants. I have attached pictures of my lower eyelids for your review.

A: Thank you for your inquiry and sending your pictures. I can clearly see the depression along the medial half of the right infraorbital rim. As you probably know there are a variety of materials to build up the infraorbital rim. Since the deficiency is really caused by a soft tissue problem (due to the excision of tissues) one could argue that either fat injections or the actual placement of a dermal-fat graft would be the most appropriate technique give the source of the problem. With your history, injections would understandably not be appealing. This leaves the choice then between he dermal-fat graft and a tear trough implant. Each one has their own advantages and disadvantages. But certainly the main advantage of a tear trough implant is its volume stability moving forward.