Plastic Surgery
Dr. Barry Eppley

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Double Board-Certified Plastic
Surgeon Dr. Barry Eppley

OR Snapsots – Tear Trough Implants


The tear trough deformity has become well recognized today and is a natural consequence of the attachments of the lower eyelids and infraorbital rim bone. Originally called the nasojugal fold, it is a sulcus that runs downward and outward from the inner corner of the eye. It is formed by the fascial attachments to the periosteum at the orbital rim between that of the orbicularus oculi and upper lip muscles. This creates a hollow area under the eye that often appears as a dark circle.

Tear troughs become magnified with age and particulalry with poor underlying skeletal support. Recessed orbital rim bone makes tear troughs look deeper and allows lower orbital fat to appear as if it is prolapsed or herniated.

The most popular treatments for tear troughs are injectable fillers and, as an isolated procedure, can be very effective. Surgical treatments for tears trough come into play usually because a lower blepharoplasty procedure is being done for an overall periorbital improveent.These include a variety of fat grafting techniques as well as implants.

tear-trough-implants-screw-fixationThe well known silicone tear trough implant was developed over two decades ago to avoid the problems with free and pedicled fat grafts. They are most commonly placed through eyelid or intraoral incisions. Available in differing sizes they are placed along the infraorbital rim staying above the infraorbital nerve foramen. Their placement requires a full arcus marginalis release. The best method to ensure permanent implant placement is small microsrew fixation to the bone. (only the subciliary eyelid incision allows this to be done)

Dr. Barry Eppley

Indianapolis, Indiana

Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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