AIM: To evaluate the effect of releasing the orbicularis retaining ligament (ORL) complex of the tear trough combined with the transconjunctival blepharoplasty in the surgical management of tear trough deformity compared with the effect of blepharoplasty alone. METHODS: A prospective, randomized (by closed envelope technique), controlled surgical trial which included 50 patients (100 eyes) with bilateral visible tear trough deformity and lower eyelid fat bulging, was divided into two groups where 25 patients (50 eyes) had tear trough-ORL release with blepharoplasty and 25 patients (50 eyes) didn’t. Qualitative and quantitative assessments of tear trough deformity were done at 6mo postoperatively, achieving grade 0 or 1 of Barton’s classification was considered a success. Standardized photographic documentation of each patient was done pre and postoperatively, also assessment of the patients’ satisfaction postoperatively was done and ranked as excellent, very good, good or fair. RESULTS: There was statistically significant difference between the two groups in the overall aesthetic results postoperatively regarding the qualitative and quantitative analysis of the tear trough deformity, where patients who had tear trough-ORL complex release had more successful outcomes than those of the second group. CONCLUSION: ORL release should be done in patients with tear trough deformity in order to release the tethering effect of this ligament which causes the prominence of the naso jugal groove.