Will Injectable Fillers Fix My Tear Troughs?

Q: Dr. Eppley, Dr. Eppley, I am 20 years old but have had prominent “tear troughs” all of my life, my left tear trough being more prominent than my right. I am very interested in getting injectable fillers for that area. I was wondering if you would be able answer a few questions for me. Would you recommend fillers for my tear troughs? If so, what kind and how much filler would you most likely use? How much would it cost? Is this something that you perform often? Thank you for your time.

A: Based on just the one side view picture you have shown, you do not have a true tear trough deformity. Rather you have pseudo or seemingly tear troughs when in fact it is caused by something else. What it appears you have is congenital herniated lower eyelid fat pads. This causes a fullness/bulging/bags of the lower eyelids which subsequently creates a tear trough appearance due to the bulge above an otherwise normal tissue area along the infraorbital rim. (lower eyelid socket) Injectable fillers would be contraindicated in this type of lower eyelid anatomy. Conversely you need removal and/or translocation of the lower eyelid fat pads. Some would be removed while a portion would be moved to drape over the infraorbital rim, thus eliminating both the lower eye bulge and the tear trough at the same time. This operation is known as transconjunctival lower blepharoplasty with fat transposition.