Filler Under Eyes VS Lower Blepharoplasty? (photo)

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?

Doctor Answers (12)

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

West Palm Beach Plastic Surgeon
4.5 out of 5 stars 7 reviews

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.

Amiya Prasad, MD
New York Oculoplastic Surgeon
4.5 out of 5 stars 35 reviews

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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.

Edward Szachowicz, MD, PhD
Minneapolis Facial Plastic Surgeon
4.5 out of 5 stars 13 reviews

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.

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 23 reviews

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. 

Jessica Kulak, MD
Fairfax Facial Plastic Surgeon
5.0 out of 5 stars 13 reviews

Transconjunctival Blepharoplasty or Fillers

Both surgery and fillers are options. A transconjunctival 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.

Robert F. Centeno, MD, FACS
Fairfax Plastic Surgeon
5.0 out of 5 stars 39 reviews

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

Steven J. Covici, MD
Springfield Oculoplastic Surgeon
4.0 out of 5 stars 14 reviews

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

Stephen Weber, MD, FACS
Denver Facial Plastic Surgeon
5.0 out of 5 stars 44 reviews

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.

Curtis Wong, MD
Redding Plastic Surgeon
4.5 out of 5 stars 17 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.