The puffiness created on the lower lids is a result of herniated 3 fat pads in the lower lid area. A trans-conjunctival approach for a conservative fat removal is usually required to address removal of the puffy look. We do not recommend fillers around the eyes in our practice. For many examples, please see the link below to our eyelid surgery photo gallery
Fillers for the lower eyelids and midface are certainly reasonable options especially at your age. I generally use Restylane for the tear troughs and Voluma for the cheeks as necessary. I have typically used Belotero for the fine lines around the mouth and superficial depressions. In general, fillers tend to stay longer around the eyes and I have patients who have had Restylane last as long as 7 years and beyond.
Surgery can be done from behind the lid in your case so there is no visible scar. The advantage here, of course, is that you get the problem resolved and that's generally it. No need to come back and get the area refilled. This approach has also proven to be very safe and effective.
The under eye area can age in many different ways and the eyes are generally the first place to show signs of aging. There are three fat pockets in the lower eyelid and the ligament that holds them in place can relax and allow the fat pockets to protrude. Shadows and hollows can be created in this process. Surgery works to remove or reposition these fat pockets. More recently fillers have been used commonly to delay or avoid surgery. Fillers act to lift the hollow areas to match the prominence of the fat pockets to create a smooth surface. In general I prefer to use Belotero or Restylane in the under eye area because it tends to cause less swelling. These products are injected with a needle so there is a chance of bruising. Be sure to avoid any blood thinning medications such as aspirin, ibuprofen , Advil or Aleve for 1 -2 weeks prior to injection to decrease the chance of a bruise. These should not look 'lumpy' after injection, although there is some swelling that can occur. In general start with smaller amounts of filler. You can always add more later. Icing before and after injection can help to decrease the amount of swelling.
The photograph is not under standardized lighting and it's often best to evaluate the lower eyelid in-person. However, certain recommendations can be offered.
Fillers like Belotero and Restylane can be effective in some individuals that are seeking lower eyelid improvement. However, most of the time the fillers can leave the area looking worse (puffier, boggy), especially if you are not a good candidate.
It appears from the photograph that fillers would be minimally effective in your case. Better alternatives, in my opinion, would be fat augmentation or a lower blepharoplasty the repositions the fat pads versus removing the fat pads.
I hope this helps.
keep in mind that much of what you will see on the Internet is going to be one of 2 extremes.either the very best for the very worst.you can absolutely have bruising when injecting in the tear trough area so keep that in mind when scheduling an injection around social or professional appointments. Based on your photos these fillers seem like reasonable choices. For the tear trough I prefer either Restylane or Belotero. The juvederm is a fine choice for the mid face or the cheeks. Radiesse would also be a good choice for the cheeks.
Best of luck
Chase Lay, MD
Double board-certified facial plastic surgeon
Considering that you are in your 30's and haven't tried any cosmetic options yet, it is a good idea to start with a conservative approach to your issue. Fillers typically last for up to a year under the eyes. You can have one syringe put in your area of concern and see if you like the results. More filler can always be added to achieve the look you desire. If you do not like the results fillers can be dissolved.
Whenever a needle enters the skin a bruise can form. This being said, you are likely to have more swelling and bruising from a blepharopasty than from fillers. To achieve smooth results, it is important to massage the filler after it is injected. I usually recommend starting massage the day after you have filler injected for 5 minutes twice a day for 2 days. This helps the filler meld and blend with the surrounding tissue.
I typically recommend a bleaching cream that contains 4% Hydroquinone along with fillers to the tear troughs. This helps correct some of the associated dark skin under the eyes.
Fillers like Belotero or Restylane are a reasonable temporary means of cosmetic improvement for lower eyelid hollows and cheek depressions. Micro-fat grafts which are long lasting are another option as well as a blepharoplasty.
Robert Singer, MD FACS
La Jolla, California
Yes you are a candidate for these fillers, if you are not looking to have surgery just yet. The fillers are placed in the hollow areas, around the fat pockets, and it camouflages the shadows produced by the fat. You will see a smoother transition from the lower eyelid to the cheek which makes the area look more youthful.
I regularly use the two fillers you mentioned in that area in my younger patients and the results are fantastic. There are potential complications that you have mentioned, as with any procedure, you should have it done by someone with experience.
Yes, fillers would work well for you at this point, but it takes an experienced and artistic touch around the eyes that many injectionists don't have. Donna London in West Linn is where I send all my patients. You can reach her at 916-995-6375.
If you are trying to delay surgery than the options indicated are GREAT!. In fact try those before having surgery...