I am a 32 year old female and looking for the best treatment for under eye hollows/wrinkles. I went to a derm to discuss fillers. To my surprise, she recommended a lower blepharoplasty instead of fillers. With work, surgery really isn't an option. Is there ANY filler that will treat under eye hollows/wrinkles? If so, is it better to inject them into the cheeks or tear troughs?
Filler Under Eyes VS Lower Blepharoplasty? (photo)
Doctor Answers (12)
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Facial Filler vs. Lower Eyelid Surgery for Bags
A common question to lower eyelid area cosmetic improvement. Generally, there are a few options to improve the appearance of the lower eyelids, eye bags, or dark circles. First option includes basic skin care, tretinoin, and/or chemical peels. This nonsurgical method helps improve the skin quality, reduce pigmentary changes, and improves overall appearance of the lower eyelid & cheek areas.
Second more advanced option is an injectable filler or fat to plump up the area. Fillers are made of material that slowly dissolves over time. Facial fillers treatment is performed in the office vial local anesthesia. Hyaluronic acid fillers, such as Restylane or Belotero, have been used to smooth the lower eyelid area. Facial fillers for lower eyelid area are typically placed in the "valleys" or depressions of the eyelid. Results last several months or year.
The last option, and also the most aggressive, is eyelid plastic surgery. Cosmetic surgery of the lower eyelid may remove or reposition fat in the eye bag area, and possible remove some sagging skin. Plastic surgeons typically don't recommend cosmetic eyelid surgery in young patients. However, each patient is unique and circumstances may vary. Age alone is not a determining factor if a person is a cosmetic surgery candidate.
Only after a comprehensive evaluation can a specialist help determine appropriate options for you. Best of luck.
Fillers NO byVillar
A thorough physical examination (touch and feel) is essential to determine the appropriate technique suited for each individual patient. Poorly lit photos will generate a lot of bad advice. Do not waste your time with fillers. It is always better to do the best procedure that deals with the problem and get it right the first time.
In skilled hands you could reasonably return to work in one week. Full unrestricted activity is typically at three weeks. Best wishes. Knowledge is power. Luis F. Villar MD FACS
Details about fillers and consideration for quick recovery eyelid surgery
I’m impressed that the dermatologist recommended blepharoplasty. In my area in Upper East Side Manhattan and in Garden City, Long Island, there are lots of non-surgical physicians who try to address under eye bags by adding volume. Unfortunately, a lot of these efforts are very misguided.
Anatomically, facial aging, which I actually wrote in my book “The Fine Art of Looking Younger”, is a couple of different processes that includes volume loss. When I do an evaluation of the eye area, I always look at the eye and the cheek because there is a relationship between the aesthetics of the eye and the cheek area. As we get older, the tissue gets thin, and trying to fill thin tissue to compensate the loss of bone, muscle and fat may soften the area of contrast between the eyelid and cheek, which makes a lot of people look very strange. In fact, a significant number of patients come to our office every week to have their Restylane and Juvederm filler placed in their tear troughs removed, which we do with an enzyme called hyaluronidase in order to stop their eye bags from looking even worse.
Clearly there’s puffiness under your eyes and that puffiness is called lower eyelid fat prolapse. This means that the fat normally behind the eye pushes forward and creates a hill. This hollow is actually the contrast between the high hill and the valley of the tear trough that makes it look deep.
20 years ago, I was determined to help people who don’t have time to recover from eyelid surgery get back to normal life as quickly as possible, so I developed a particular style and process of doing eyelid surgery that is called a quick recovery approach. For the right candidate, we can do a procedure on a Thursday or even Friday and reduce the puffy bags under the eyes and allow them to get back to work on Monday. We use the weekend as a big part of the healing process. Day by day, a little bit of fluid and swelling resolves and nobody knows what’s going on until you look better.
I suggest that you shouldn’t completely take out the option of having surgery because there are techniques that allow people to recover quicker than you expect. These include surgical technique, anesthesia and the after care. The puffiness under your eyes is so significant that your dermatologist thinks that softening the tear trough would probably not make enough of a difference in compensating the puffiness. You may want to save your money and wait for the right time to do the lower eyelid surgery first and maybe combine it with something to address the eyelid cheek hollowing in the future. I hope this was helpful, and thank you for your question.
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Filler Under Eyes vs Lower Blepharoplasty
The cheek begins to drop and the smooth fat under the skin begins to thin with age. Restoring volume to the cheek area is a good way to rejuvenate the upper face.
Sculptra is a filler which promotes new collagen to form, and lasts longer than gel fillers. I have seen gel fillers cause puffiness in the under eye area, so I recommend being conservative around the eyes with gel fillers.
Fillers vs fat repositioning
Both fillers to the tear trough/cheek and lower lid blepharoplasty with fat repositioning are valid options. If taking 1-2 weeks off from work is not an option for you, then fillers are the way to go. Juvederm, Restylane, or Boletero can be used in this area. A combination of injection to the tear trough and the upper cheek would give you the best outcome.
Surgery vs filler
Both a lower eyelid surgery and fillers could be helpful in improving the appearance of your lower eyelids. The fillers, such as Restylane or Belotero are temporary lasting 6 months to a year. Filler injections to the tear trough area and along the orbital rim would soften the appearance of hollowness around your eyes. A lower eyelid surgery or blepharoplasty would be helpful to smooth the eyelid "bags" or fat that is appears to be protruding in the lower eyelid area. This can be done through an incision inside your eyelid with around 1-2 weeks of downtime from work. Choosing the "best" procedure for you depends on many factors including your personal goals as well your current lifestyle and work limitations. If now is not the time for surgery, then fillers are a great temporary option that would provide a nice improvement until your ready for surgery.
Transconjunctival Blepharoplasty or Fillers
Both surgery and fillers are options. A transconjunctival blepharoplasty...an incision on the inside of the eyelid to remove the fat pocket would work well for you. Your recovery should not be too bad. Alternatively, a filler such as Radiesse to the cheeks and Restylane to the lid cheek junction and tear trough would help significantly. All the best.
Lower Lid Blepharoplasty
Based on your photos, I think you would do best with a blepharoplasty. It will give you a better result and ultimately be more cost effective. Find a surgeon who will do a fat transferring technique which will transpose fat into your tear trough. Hope this helps.
Steven Covici, MD
Both filler and lower blepharoplasty are reasonable options to improve your lower eyelids
Both filler and lower blepharoplasty are reasonable options to improve your lower eyelids. Surgery will require about 7 days of downtime to recover from any swelling or bruising but will give you a long-term improvement in the lower eyelid bags. Filler, on the other hand, has minimal downtime (any bruising can be covered up immediately with makeup) but is temporary lasting from 6-12 months. Both options will work well for you. I hope this information is helpful.
Stephen Weber MD, FACS
Best procedure for lower lid bags
If you want something more permanent, then a surgical lower lid blepharoplasty would be best approaching this from inside the eyelid with the bag transposed over the orbital rim. If you're okay with temporary treatments, you can consider filler in the troughs. As an alternative, you could consider fat grafting if you're willing to accept the risks of fat grafting. The answer all depends on what you are wanting to do and what costs and risks you are willing to accept.