Addressing Under-Eye Concerns: When To Choose Tear Trough Filler Or Eyelid Surgery

Under-eye concerns are some of the most common aesthetic issues patients seek to address, driven by factors such as aging, genetics, and lifestyle choices. Whether it’s dark circles, puffiness, hollow eyes, wrinkles, or sagging skin, these concerns can affect one’s appearance and confidence. Fortunately, there are effective treatments available, including tear trough fillers and eyelid surgery. But how do you know which option is right for you?

Photo Credit: Dmytro Buianskyi/Shutterstock

Common Under-Eye Concerns

The most common under-eye concerns patients seek treatment for are:

  • Dark circles: Often caused by thinning skin and blood vessels, dark circles can make the eyes appear tired and aged.
  • Puffiness: Fluid retention or fat protrusion under the eyes can create a puffy, swollen appearance.
  • Hollow eyes: Volume loss in the tear trough area can result in hollowed, sunken eyes, often giving a fatigued look.
  • Wrinkles: Fine lines and wrinkles around the eyes are a natural part of the aging process.
  • Sagging skin: As skin loses elasticity with age, it may sag, contributing to a tired, drooping appearance.

Tear Trough Fillers vs. Eyelid Surgery

When it comes to addressing these concerns, there are two primary treatment options: tear trough fillers and eyelid surgery (blepharoplasty).

Tear Trough Fillers: Tear trough fillers are non-surgical, injectable treatments used to restore volume to hollow or sunken areas under the eyes. By injecting hyaluronic acid or other filler substances into the tear troughs, the filler smooths out the under-eye area, reducing shadows and creating a more youthful, refreshed appearance.

This treatment is ideal for individuals dealing with mild to moderate volume loss in the tear trough area. The results are temporary, typically lasting between 6 to 18 months, depending on the type of filler used and individual factors. Tear trough fillers require minimal downtime and are a quick, minimally invasive solution.

Eyelid Surgery (Blepharoplasty): On the other hand, eyelid surgery, or blepharoplasty, is a more invasive option suited for individuals with significant under-eye concerns. This surgical procedure removes excess skin, fat, or tissue from the eyelids to address puffiness, sagging, and drooping eyelids. Blepharoplasty can provide long-lasting, often permanent results, making it ideal for patients who need more substantial correction.

While eyelid surgery offers dramatic results for those with more severe concerns, it requires a longer recovery time and comes with the risks associated with any surgery. It is often recommended for those experiencing excess skin and fat protrusion that fillers cannot fully correct.

Choosing the Right Treatment for You

When deciding between tear trough fillers and eyelid surgery, there are several factors to consider:

Ideal Candidates for Tear Trough Fillers: Tear trough fillers are best suited for patients with mild to moderate hollowing or volume loss under the eyes. If you’re looking for a quick, non-invasive solution with minimal downtime, fillers can provide immediate improvement. They are also ideal for patients who are not ready for surgery or prefer a less permanent solution.

Ideal Candidates for Eyelid Surgery: Eyelid surgery is better suited for individuals with significant sagging, excess skin, fat protrusion, or drooping eyelids. If you’re dealing with more advanced aging signs that fillers cannot fully address, eyelid surgery can provide dramatic, long-lasting results. Keep in mind, however, that surgery requires a longer recovery time and carries the risks inherent in any procedure.

Longevity and Effectiveness

One of the key differences between these two treatments is longevity. While tear trough fillers offer temporary results that last up to 18 months, eyelid surgery provides permanent or long-lasting results. However, surgery comes with a recovery period that typically requires a few weeks for healing, whereas fillers offer the convenience of minimal downtime.

Advice for the Uncertain

If you’re unsure whether to start with fillers or opt for eyelid surgery, it’s important to assess the severity of your concerns and your personal goals.

  • Start with fillers if you have mild to moderate under-eye hollows or volume loss. Fillers offer a temporary, non-invasive solution with little downtime and can give you a taste of how you’d look with enhanced volume and a rejuvenated appearance.
  • Consider surgery if you have significant sagging or excess skin around the eyes that fillers won’t effectively address. While surgery requires recovery time, it provides long-lasting results that can dramatically transform your appearance.

The best course of action is to consult with a qualified aesthetic specialist, such as Haute Beauty Ambassador Dr. Sachin Shridharani of LUXURGERY, who can assess your unique needs and help determine which treatment is most appropriate for you.

Addressing under-eye concerns is a personal journey, and the choice between tear trough fillers and eyelid surgery depends on your specific needs, goals, and the severity of your concerns. Fillers offer a temporary, non-invasive option for those seeking a subtle, youthful refresh, while eyelid surgery is ideal for those needing more extensive correction. Whatever route you choose, working with an experienced professional will ensure the best possible results for your unique needs.

For more information, visit Sachin Shridharani, MD, FACS's social media: