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Should I Have a Blepharoplasty Instead of Restylane?

I am 48 with lax under eye skin, hollowness and herniated fat. I was told by one PA that I needed lower blepharoplasty and another said that I needed Restylane injection because lower blepharoplasty would cause more hollowness.

I am scheduled for Restylane this week but now not sure. I had upper eyelid surgery 2 years ago but my under eye area makes me look much older. I’m afraid that Restylane will just cause puffiness and I’ve read a lot of people were unhappy with it.

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15 Doctor Answers | Asked by vabeckaboo in Richmond

Doctor Answers (15)
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Sometimes multiple procedures are needed

The lower eyelids go through many changes as we age. The fat around the eye starts to bulge out causing the bags, and the fat over the bone under the eye starts to droop downward with the cheek. With the goal being to restore the youthful smooth contour of the lower eyelid/cheek complex, you probably need some of the fat removed to reduce the bags, with some injection of either Restylane or fat over the bone to fill in the depression. Be sure to discuss these options thoroughly with your... more

At Age 48, Restylane in the Tear Troughs is a "B" Procedure

Although Restylane is an option in the tear trough region, the results provided by the procedure combined with the frequency of complications, makes it a second tier procedure. The problem with filling the tear trough lies in the anatomy: a confluence of thin skin, muscle, and the bone of the orbital rim that is difficult to fill significantly. One of the most common problems is a bluish discoloration and swelling known as the Tyndall effect. I have seen this problem... more

Restylane is not FDA-approved for use around the eyelids

Restylane is not FDA-approved for use around the eyelids and should be avoided. In our practice we have seen multiple patients who come in with puffiness around the eyes that has lasted over a year, made by inadvertant placements of Restylane around the eyelids. It is not a good idea. The goal of a lower blepharoplasty is primarily to remove the fat pads which cause puffiness in the lower lids, and sometimes take a small pinch of skin if there is excess skin noted on the lower lids.... more

Make sure your surgeon performs both

When in doubt about the choice between two techniques, make sure the advice you consider comes from someone who is expert at both. We love fillers and fat around the eyes and have performed hundreds, if not thousands of blepharoplasty procedures. The choice advantages and disadvantages should be presented to you in such a fashion that the best choice becomes obvious.

Sounds Like You Need Surgery

A blepharoplasty does not have to make you more hollow-only if excess fat is removed will this happen. So I would suggest, without the benefit of pictures, a lower lid canthopexy, muscle tightening and skin removal-no fat. If you are still hollow after this I like to use Radiesse. This can be injected down near the bone to pump up the tissues without the lumpy/bumpy look you can get from a more superficial hypaluronic filler. I don't think you'll get much bang-for-the-buck with Restylane... more

Should consider surgical option

You would be best served by having a lower eyelid blepharoplasty. There are a number of techniques that could give you an excellent and long lasting result. Injectable fillers in this area can be done. The injection needs to be deep at the level of the orbital rim and used sparingly. It sounds like your condition is past the point where a soft tissue filler would be beneficial

You need to have the right kind of lower blepharoplasty.

Hi! It sounds to me like Restylane would be a bandaid approach for you. The typical lower blepharoplasty will indeed make you look more hollow because fat is taken out. You probably would do best with an operation that repositions the fat or with fat injections to create a smooth contour. These are tricky procedures. Go to a board certified plastic surgeon who does a lot of eyelids. Listen to what he says. Ask to see a lot of before and after pictures.

Consider This.

Resytlane is temporary, so even if you hate it, it will go away. It may be worth a try as the cost and down time are less than surgery. On the other hand, lower bleph doesn't have to make the hollow eye worse. Some techinques to move the fat, or even give some lift to the cheek can be employed. As the other doctors have said, you need to have a good evaluation to help determine the best treatment for you. sek

Best to consult a board-certified plastic surgeon

A "two pronged approach" using fillers and surgery is the modern approach to facial aging. There are things that can only be done with fillers, and there are things that require surgery. A consultation with a Board Certified Plastic Surgeon would be best to advise you. You can check what a doctor is board certified "in" at the the web site for the American Board of Medical Specialties. I use both techniques and suspect that you may already be a surgical candidate. Discuss this in person... more

Avoid filler injections around the eyes

I strongly advise against filler injections like Restylane around the eye. The eyelid skin is very thin and the filler is often very visible and shows irregular lumps around the eyelid. The companies do not recommend it so this is an "off label" use. If that is not enough to dissuade you, there has been a case of blindness in England caused by filler injection around the eye. The modern approach to blepharoplasty for lower eyelid rejuvenation is to use a transconjunctival incision... more

Lower eyelid and upper cheek treatment

Without seeing photographs of your eyes, it is difficult to give you specific advice. That being said, treatment of the lower eyelid and upper cheek is complex, and you should only seek advice from an experienced plastic surgeon. The aging process in the lower eyelid and upper cheek is multi-factorial and different in everyone. It depends on a lot of factors: Your age Your genetics Your exposure to sun, smoke and toxins The thickness and elasticity of your skin Your cheek/orbital bone... more

Please have a consultation by a plastic surgeon

You have explained your condition but a picture would have been more helpful. If you have extra skin then lower belphoplasty will be helpful. Your plastic surgeon will be able to examine and give you better answer and when you go to the consultation do not mention restylane till you doctor finish his examination. IF YOU ARE NOT SATISFIED WITH THE ANSWER ,PLEASE GET A SECOND OPNION.

Kamran Khoobehi, MD

28 reviews

New Orleans Plastic Surgeon

Helpful to consult plastic surgeon offering both procedures

Should you have surgery or an injectable? Tough question to answer without a thorough examination. An injectable can fill in the tear-trough under the fat and improve the overall look of the eyes. Longevity is pretty good in our experience, Restylane may give you a good year or so. It will not improve skin excess though. Modern blepharoplasty can be performed without creating hollowness, we like to perform fat repositioning: reduce the herniated fat and use it to fill in the tear trough.... more

Please do not rely on a PA for making this type of decision.

Dear Vabeckaboo Please do not rely on a physician's assistant for making this type of medical decision. As great as they might be as a person they do not have the insight of an actual cosmetic surgeon. I would highly recommend you seek a second opinion of a board certified ophthalmologist in you area with fellowship training in oculoplastic surgery and elected to the American Society for Ophthalmic Plastic and Reconstructive Surgery. This organization has a website: ASOPRS.org which has a... more

Kenneth D. Steinsapir, MD

8 reviews

Los Angeles Oculoplastic Surgeon

Neither is the right solution

In your case, some photos would be helpful. If what you describe as 'herniated fat' and 'lax under eye skin' is truly the case, then a lower blepharoplasty would be a partial solution. The 'hollowness' that you describe is likely a reference to the development of a visible junction or trough between lower eyelid and cheek, which is a classic sign of facial aging. Restylane or other dermal fillers have been used to replace the soft tissue in this region, but a much better solution is to... more