Do I Need Fillers Or Surgery For My Tear Trough Issue?

February 3, 2019

Thanks for your question and photos. You have fairly prominent excess orbital fat, which causes bulging in the lower eyelid area. The bulging also appears to be a bit uneven, with more on your left side than on the right. The best solution is to remove the excess orbital fat; this is what is done by a lower lid blepharoplasty. A filler injection into the “tear troughs” would also help but would only address the more medial area between the eyelid and nose (see accompanying video). 

You appear to have some volume loss in the maxillary area, the cheek area beneath the eyelid. This “flattened” area is evident on the side view photograph. The maxillary area can be effectively filled with hyaluronic acid fillers placed beneath the skin, just above bone level. Another good choice for longer-lasting results is Bellafill.


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Dr. Robert Langdon

Dr. Robert Langdon, MD is a triple-board-certified cosmetic surgeon in Dermatology, Cosmetic Surgery, and Facial Cosmetic Surgery. He specializes in advanced laser and low-impact procedures under local anesthesia, emphasizing quick recovery and low risks. With over 30 years of experience, he prioritizes personalized care and has authored significant publications, including a book on cosmetic laser surgery.

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