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Candidate For Transconjunctival Blepharoplasty or Restylane Filler?

asked 1 year ago by MeganOnley26 in Washington, DC
Latest answer by Rian Maercks, MD
Question viewed 2,009 times
Tags: age 25-34, female, candidate, comparison, glasses, puffy eyes

I am 27 years old and suffer from under-eye puffiness. I'm in dire need to correct this situation in order to restore my youth and happiness and not hide behind my glasses as I've been doing for years. Am I candidate for the less evasive Restylane filler? Or would you recommend full Transconjunctival Blepharoplasty?

32 answers to Candidate For Transconjunctival Blepharoplasty or Restylane Filler?

+3

Treatment of eyelid bags

You look like you would be a good candidate for a TCLB- transconjunctival lower blepharoplasty. Filler works too, but in order to conceal the puffiness, you need to fill up to such a level that the eyes appear puffy. Your problem often runs in the family and has nothing to do with aging of the eyes.
Brent Moelleken, MD

Beverly Hills Plastic Surgeon

www.drbrent.com

+2

Blepharoplasty vs Restylane

I do not think you will benefit from Restylane.  You photo indicates that you probably have pseudoherniation of the fat pads of your lower eyelids.  The best treatment of this would be a transconjunctival lower lid blepharoplasty.  I occasionally see this in younger patients such as you; I think this most commonly represents a familial tendency when seen in the young.
John Whitt, MD

Louisville Plastic Surgeon
+2

Transconjunctival blepharoplasty for eyelid bags.

Transconjunctival blepharoplasty for eyelid bags will be the treatment you need since the bags are quite large. Fillers will make things worse.
Toby Mayer, MD

Beverly Hills Facial Plastic Surgeon
+2

Transconjunctival Blepharoplasty

Hi Megan, You are definitely a candidate for a transconjunctival blepharoplasty. The bulging that you see is orbital fat herniating out causing the puffiness. A transconj blepharoplasty is quick and safe to do and will correct the puffiness under your eyes. This procedure can be done under local anesthesia and recovery is about 4 to 5 days. You can check my website below which is dedicated to ethnic facial cosmetic surgery. Best, Dr.S.
Oleh Slupchynskyj, MD

New York Facial Plastic Surgeon
+2

Candidate For Transconjunctival Blepharoplasty or Restylane Filler?

Thanks for the posted photo. It really helps advise. I recommend transconj. lower bleph. as the first option to remove the medial/central fat pockets. This would be under local + sedation. Healing in most cases 1 week. From MIAMI 
Darryl J. Blinski, MD

Miami Plastic Surgeon
+2

You are an ideal candidate for transconjunctival lower blepharoplasty

I am a huge fan of fillers for the improvement of lower eyelid bags- especially in young people.  The vast majority of the time, lower eyelid bags are caused by age-related volume loss that show up first along the lower orbital rim.  This accentuates the "valley" between the cheek and the lower eyelid, making the lower eyelid bags painfully obvious.  Fillers can expand this "valley" and restore a smooth contour to the lower eyelid-cheek continuum. Your... more
Tanuj Nakra, MD

Austin Oculoplastic Surgeon
+1

Treating eyelid puffiness

You are indeed one of the few patients that would truly benefit from the transconjunctival approach. I would however recommend fillers before or at the same time as the blepharoplasty to avoid bringing attention to flatness of your midface. I would also recommend a fat transposition approach to the transconjunctival blepharoplasty instead of removing fat. I hope this helps! All the best, Rian A. Maercks M.D.
Rian Maercks, MD

Miami Plastic Surgeon

www.rianmaercksmd.com

+1

Fat pads or swelling of lower eyelids

You will need an examination with a plastic or oculoplastic surgeon to evaluate what is causing the bags. If they are fat pads, then a transconjunctival blepharoplasty would be indicated. If they are fluid bags of swelling then you won't benefit by the surgery and fillers could make it worse by retaining more water. Please see an excellent surgeon who has great experience with blepharoplasties.
Ronald Shelton, MD

Manhattan Dermatologist
+1

Lower eyelid surgery to remove fat bags

You photos show the classic signs of lower eyelid fat bags in the central and medial fat compartments. Lower eyelid surgery through a transconjunctival approach would take about 30 minutes and would resolve the issue. Do not waste your money on soft tissue fillers that will make the area appear larger and more full.
Francis R. Palmer, III, MD

Beverly Hills Facial Plastic Surgeon
+1

Restylane vs. Trasconjunctival Blepharoplasty

They accomplish related but different things-  the Restylane fills in the tear troughs, minimizing the appearance of the fullness/bagginess of the lower lids, while the transconjunctival blepharoplasty removes that fullness/bagginess.  It is necessary to evaluate photos at a minimum to determine what is the best procedure for you.
Jeffrey Epstein MD, FACS

Miami Facial Plastic Surgeon
+1

Transconjunctival blepharoplasty needed, not filler

The puffiness on the lower lids is caused from herniated fat in the lower lids pushing outward on the orbital septum.  There are 3 compartments of fat in the lower lids.  It is important to make sure that there are no preexisting allergies and if so, they should be well controlled with either nasal sprays or antihistamines.  If the puffiness is still present, a transconjunctival blepharoplasty is an excellent choice for fat removal in both the middle and medial compartments... more
William Portuese, MD

Seattle Facial Plastic Surgeon

www.seattlefacial.com

+1

Filler or Eyelid Lift for Bags

Fillers like Restylane or Juvederm can be very effective in masking eyelid bags or puffiness by injecting around the fat pockets creating the bags.  When the bags are very prominent, as it appears in your case, you would have to add a lot of filler to create a smooth contour sometimes leading to eyelids that are too "full".   Transconjunctival blepharoplasty is a way of removing those fat bags causing the bulging without any visible external incision or scar.   From... more
James C. Marotta, MD

Long Island Facial Plastic Surgeon

www.marottamd.com

+1

Filler vs Surgical correction

I personally do not perform Transconjunctival Blepharoplasty, however some dermatologists do. This would truly be a question better suited for a plastic surgeon. I have performed numerous dermal filler procedures under the eyes and you would need an adequate exam before determining if the desired goal can be achieved with dermal filler alone.
Peter L. Kopelson, MD

Beverly Hills Dermatologic Surgeon
+1

Blepharoplasty versus Restylane filler

Correction of lower eyelid "bags" may be obtained using a number of different treatments, such as injection of hyaluronic acid fillers such as Restylane or Juvederm, by skin tightening procedures such as lasers, or by surgery. You should consult with an experienced surgeon for a complete physical examination and full discussion of all the options, their benefits, risks and complications.
Olivia Hutchinson, MD

New York Plastic Surgeon
+1

Transconjunctivalunctival blepharoplasty is a great option to remove lower eyelid "bags"

Dear MeganOnley26,  Transconjunctival blepharoplasty is a great option to remove your lower eyelid "bags." Hyaluronia acid fillers or fat injection are an option but run the risk of contour deformity (bumps), asymmetry or Tyndall effect (bluish discoloration from filler). Fillers also won't address the problem which is pseudo-herniation of fat into the lower eyelid. Seek an experienced aesthetic surgeon with alot of facial surgery experience. Stephen Weber, M... more
Stephen Weber, MD

Lone Tree Facial Plastic Surgeon

www.lonetreefacial.com

+1

Transconjunctival blepharoplasty or Restylane filler for lower eyelid bags

As you can see from the various answers there is certainly a difference in opinion on how to handle your situation. I have found that in cases of young individuals like yourself with obvious herniated lower eyelid fat, that a transconjunctival blepharoplasty can achieve very satisfying results. This does not address the fact that your mid face is not very prominent. That would be better addressed with an injectable filler but I think that this would not be a significant issue if you no... more
William F. DeLuca Jr, MD

Albany Plastic Surgeon

www.delucaplasticsurgery.com

+1

Either Blepharoplasty Surgery or Restylane Injection for Lower Lid Fat Bags

Megan, I think you would be an excellent candidate for blepharoplasty surgery to remove and possibly reposition your lower eyelid fat pads.  Alternatively, a skilled Restylane injector should be able to disguise your lower lid fat bags if you would prefer a nonsurgical treatment.
Michael McCracken, MD

Boulder Oculoplastic Surgeon
+1

Radiesse vs blepharoplasty

Injectable filler may help camouflage the puffiness, which is likely caused by protruding lower eyelid fat. I prefer Radiesse in this area because it may cause less puffiness than hyaluronic acid fillers, like Restylane and Juvederm, which can pull in water. However, surgery will be a more definitive correction in general--more permanent and more complete. The main advantage of the filler is that it avoids the risks and down-time of surgery.
Steven Goldman, MD

Cleveland Plastic Surgeon
+1

Treatment of lower lid bags needs to be individualized.

Hi. This is a very important question, because for many people, skillful injection of Restylane (in very small quantities, deeply, under the muscle) has eliminated the need for surgery. Unfortunately, I don't think you are in this category.  Your bags are too pronounced.  So you need transconjuctival blepharoplasty. But the key point to emphasize is that state of the art surgery does not just mean removing excess bulging fat.  Just removing fat can make you... more
George J. Beraka, MD

Manhattan Plastic Surgeon
+1

Candidate For Transconjunctival Blepharoplasty or Restylane Filler?

This problem, specially in younger patients, is due less developed cheek bones. Definitive treatment is placement of infraorbital/cheek combine implants with release and conservative reduction of fat pockets. The implant must be right at the level of bony ridge of the eyes to get the full effect. Lower eyelid blepharoplasty will improve the buldging of fat pockets but does not address the underlying problem. Restylane helps for a year but it is not permanent. 
Mohsen Tavoussi, MD, DO

Huntington Beach Facial Plastic Surgeon
+1

Baggy Eyelids

Based on your photos, the prominent feature is the puffiness of the lower lids due to herniated orbital fat. I would recommend transconjunctival removal of the herniated fat rather than injection of fillers such as restylane.
John Pak, MD, PhD

Chicago Oculoplastic Surgeon
+1

Fillers under lower lid bags can be tricky

You can get a great result in experienced hands, but beware that there are many tissue planes in the area under the lid bags that can carry risk of lumpiness, asymmetry, and misplaced fillers that will require touchups as time goes forward.  Your photos show that your bags are likely due to herniated orbital fat that is easily removed from a transconjunctival approach.  I would recommend the latter, although we do work with patients who choose the former.  Ask your physician... more
Randy Wong, MD

Honolulu Plastic Surgeon
+1

Eyes and puffy circles

Fillers may camouflage the bags or exacerbate them. A very easy transconjunctival blepharoplasty will remove the excess fatty tissue with no visible scar.
Steven Wallach, MD

Manhattan Plastic Surgeon
+1

Well-performed Injectable Filler treatments may be employed to reduce the appearance of lower eyelid bags. Video attached.

I read your concerns and reviewed your photo. While most experts recommend lower eyelid fat removal, in my practice, most patients with congenital lower eyelid fat bags are treated with Injectable Fillers. You can improve the appearance of your lower eyelid bags by having filler carefully placed below the bulge. In my view, this is a better option than surgery which may lead to a hollow, "operated" appearance. My personal preference is to use Silikon-1000, an off-label filler... more
Eric M. Joseph, MD

West Orange Facial Plastic Surgeon
+1

Lower blepharoplasty vs filler

Although fillers are great option for some, in your situation, transconjuctival blepharoplasty with fat removal will you give the best long-lasting result.  It can be done under local anesthesia. Dr Taban
Mehryar (Ray) Taban, MD, FACS

Los Angeles Oculoplastic Surgeon
+1

First, there is not substitute for a personal consultation with a surgeon.

Dear Megan I very much like fillers.  However looking at your photos, if you are open to having surgery, I think you would be well off to have an arcus marginalis release.  Unlike a standard transconjunctival lower belpharoplasty where fat is cut out and thrown away, fat is preserved in the arcus marginalis release.  The fullness in the lower eyelid is caused by fat  Cutting out the fat can make the eyes look hollow when all the swelling is gone.  Arcus... more
Kenneth D. Steinsapir, MD

Los Angeles Oculoplastic Surgeon
+1

Transconjunctival blepharoplasty for prominent fat

Your photo demonstrates significant fatty deposits in the lower lids which beyond the limit that a filler is likely to correct. As there is little skin laxity my vote is for a transconjunctival blepharoplasty. Filler can work very well for some, however if the fat is too prominent the filler may simply cause the eyes to look puffy. Best of luck, peterejohnsonmd
Peter E. Johnson, MD

Chicago Plastic Surgeon
+1

Eyelid surgery, #blepharoplasty, #tiredeyes, #fatgrafting, #restylane, #beauty

Dear MeganOnley thank you for your question!  Your photo is very helpful- thank you!  Adding volume to the cheeks- to correct the hollow under one's eyes can be done with micro fat grafting or Restylane.  It is difficult to determine if you need this. The puffiness can be taken care of very nicely with a trans conjunctival lower lid blepharoplasty. ( this may be combined with micro fat grafting) With Warm Regards, Trevor M Born MD
Trevor M. Born, MD

Toronto Plastic Surgeon
+1

Lower Eyelid Puffiness

The lower eyelid area can be complicated in terms of finding the right solution. I agree that both fillers and formal surgery are likely to help to reduce your problem. Of the two choices, I would suggest a lower eyelid blepharoplasty. That wil reduce the majority of the puffiness and may be all that you need. However, the valley or crease issue is typically more of a midface problem. This is where fillers make sense, especially if you are too young for a formal midface lifting procedure... more
Richard W. Westreich, MD

Manhattan Facial Plastic Surgeon
+1

Transconjunctival blepharoplasty

You have lower lid bags. Your surgeon should take a good history to make sure your condition is not related to your diet (i.e. high salt intake), hormonal imbalance (i.e. thyroid), or allergies. If it is as it appears, related to structural fat, then a transconjuctival blepharoplasty might be the ideal solution. Filler in this area can be problematic and not suited to this anatomical situation I think. Robin T.W. Yuan, M.D.
Robin T.W. Yuan, MD

Beverly Hills Plastic Surgeon
+1

TC bleph is needed

Do NOT do a filler -- you will regret it. Go to a well trained Plastic Surgeon who can evaluate you and most likely you will get a great result with a transconjunctival lower lid blepharoplasty.
William B. Rosenblatt, MD

New York Plastic Surgeon
+1

Blepharoplasty vs. Filler

I am glad you posted your photo. You are a candidate for transconjunctival blepharoplasty and should do very well with your outcome. Many patients with similar concerns are good candidates for fillers like Restylane but as you know, everyone is unique and it is best to get all the information. This surgery is typically done under a light anesthetic and is considered outpatient, meaning you go home the same day. Recovery is minimal and most patients are back to work and normal routines... more
C. Coleman Brown, MD

Bethesda Plastic Surgeon

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