Will tear Trough Implant Correct My Lower Lid Volume Deficiency After A Lower Blepharoplasty?

Q: Dr. Eppley, I had a lower blepharoplasty a few months ago and one of my eyes now looks really hollow.It started out looking great. But it was like overnight it lost all the volume. So I was wondering if a tear trough implant would be an appropriate way to treat it.

A:Right after surgery for the first 4 to 6 weeks due to swelling everything can look perfectly smooth. But whenb all the swelling goes away and soft tissue contraction occurs as part of the healing process any contour irregularities or volume discrepancies becomes apparent. This is why it takes 3 to 4 months to truly see any type the facial surgery result in its fine details.

That being said the question is whether a tear trough implant would be the best approach to addressing your right lower lid/cheek junction concerns. I don’t think it is given that the surface area’s coverage of the problem is greater than that of a  tear trough implant. Such an implant risks creating a prominent bump or lump in the volume deficient area. If one was using an implants approach it really takes a custom implant design to provide adequate surface area coverage that has a smooth transition into the surrounding bone. However I think that solution, effective as it may be, is far greater then is what is needed.

From my perspective your options are twofold. One less invasive option is fat injections which,  if well done, can restore volume. Fat injections have the advantage of being able to be placed over a broad surface area and into the area that is actually the cause of the volume deficiency (loss of fat). The other option is an onlay which is draped over the  infraorbital rim onto its anterior surface. Think of it as an ‘implant’ but it is really a sheet of cadaveric dermis which can be custom cut and shaped along the entire rim area over a broad surface. It is juice like an implant but it is really a tissue graft which will integrate into your own tissues with the volume persistence.

Dr. Barry Eppley

World-Renowned Plastic Surgeon