Which Between Fillers and Blepharoplasty Should I Have First?

asked 3 years ago by intears in Toronto
Latest answer by George J. Beraka, MD
Question viewed 1,837 times
Tags: complication, hollow

About 8 months ago, I had lower blepharoplasty and CO2 laser. My eyes are hollowed out more so than ever, and extra skin is evident to the point that I'm afraid to smile. I've seen a few doctors and they all suggest different things - another lower blepharoplasty, or fillers. Some suggest a filler first, then a snip incision, and ssome prefer Restylane and some prefer Perlane. Does the order matter? My skin in fairly thin. Which between fillers and lower blepharoplasty should I have first?

9 answers to Which Between Fillers and Blepharoplasty Should I Have First?

Bleph first

It continues to amaze me that surgeons still don't know how to do a bleph. History and excellent surgeons have taught us that "fat is youth." Most good surgeons understand that removal of fat will lead to sunken eyes. Unfortunately, you're there so let's fix it. If you still have excess skin then your surgeon used a transconj. incision to remove fat. So you need to have the skin removed, just a little bit of skin, and have the muscle tightened. After you heal, if you still have a... more

Christopher L. Hess, MD
Fairfax Plastic Surgeon

You need to find a doctor who makes sense and you trust.

Dear Intears Obviously you have a very significant problem because you have submitted multiple emails regarding your situation to Realself. This can only mean that you have not found answers that make sense to you. You need to listen to your intuition and not ignor these feelings. You need to find a doctor you can trust. This is no easy prospect as you have learned. I think I have suggested to you that you may need to travel to find your doctor. There are only a handful of us in the... more

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon

Fat injections best for hollowed lower lids.

Hi. 1) I am afraid you have a very difficult problem. You can try Restylane under your eyes, but it may complicate the situation. 2) From your description, you really need a complex revision blepharoplasty with fat injections. But this is difficult surgery. Try to see an oculoplastic surgeon.

George J. Beraka, MD
Manhattan Plastic Surgeon

Fillers are not FDA-approved for usage around the eyelids

Fillers are not FDA-approved for usage around the eyelids and should be avoided. In our practice, we have seen multiple complications from other offices where the Restylane was injected around the eyelids and created extended semipermanent puffiness underneath the eyelids for years after the injections. Patients were very unhappy with that result. If there are still issues regarding the puffiness and/or excess skin underneath the lower lids, they should be addressed with a... more

William Portuese, MD
Seattle Facial Plastic Surgeon

www.seattlefacial.com

Contouring lower lids requires multiple adjustments

Since we altered our lower lid technique about two years ago, we no longer have frequent touch ups regarding the results. We now perform as our standard a blepharoplasty, microFat or filler, skin excision or laser to address all the aesthetic concerns that transpire with lower eyelid aging. We have excellent results with fat or fill as well as pinch skin excision and fractional CO2 technology. Our technique is termed "Contour Lower Lid Blepharoplasty" because it accurated... more

Richard Gentile, MD
Cleveland Facial Plastic Surgeon

www.facialplastics.org

A mid face lifting procedure may be beneficial in this situation

If in your first surgery the area was hollowed out it is important to have a thorough evaluation looking a items such as lower lid position, the level of descent of the junction point between your lower eyelid skin and your cheek skin, any remaining fat below the eye, globe position and cheek position as well as tightness of the lower eyelid itself. If you are hollowed out and have lose skin and you have some descent of the midface then a lifting procedure may be beneficial to blend your... more

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon

Dissatisfaction 8 Months After Lower Blepharoplasty

Hi In Tears, I empathize with your despair following your eyelid surgery. Know that your situation is correctable; it will require that you find a very good opthalmo-plastic surgeon. It appears that you have seen many surgeons in consultation which is a good thing. Dr. Steinsapir has given you very good advice. You may want to speak with him, or Robert Goldberg, MD at UCLA. Both are excellent surgeons experienced in revision blepharoplasty here in Los Angeles. If your excess lower lid... more

Michael A. Persky, MD
Los Angeles Facial Plastic Surgeon

See an Eyelid Expert first

When there is a problem that affects the eyelids, you should be evaluated by an Ocular Plastic Specialist. These doctors, like Kenneth D. Steinsapir, MD and myself, are Eye MDs who have specific further training in cosmetic and plastic surgery around the eye. There are some excellent American Society of Ophthalmic and Plastic Reconstructive Surgery physicians in Toronto (where I completed my fellowship). To answer your question , the order of filler and / or skin removal or tightening is... more

Mark Berkowitz, MD
Sterling Heights Oculoplastic Surgeon

Do not have fillers injected around the eyes!

Filler injections around the eyes to correct dark circles, hollows and other problems frequently result in permanent visible lumps and discoloration. Filler injections around the eyes have caused blindness in a patient in England. The companies that make fillers do not recommend this use. You need to see a board certified plastic surgeon who specializes in eyelid surgery and has experience in correcting post blepharoplasty problems. I use an open transconjunctival laser blepharoplasty... more