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Filler or Lower Blepharoplasty for Lower Lids? (photo)

I am 40 and have genetic under-eye hollowness. It has become markedly worse over the past few years. I really want to do something more on the permanent side, but am now thoroughly confused: An oculoplastic doctor has said that I am not a candidate for a lower bleph/that it wouldn't make me look good. I have, however, seen that it gives amazing results on plenty of people with similar appearances. So - do I add or remove? Advice welcome! Thank you.

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14 Doctor Answers | Asked by EBH in Pittsburgh, PA

Doctor Answers (14)
Community Comments (0)

Lower lid bags

I would recommend that you try Restylane first for the lower lid bags before opting for a blepharoplasty. Based on the appearance of your cheeks, you are not ready for mid-facelift and I think you can hold off on surgery for at least five years. Restylane is an office based, inexpensive procedure which I think would produce a fine result in your case.

Blepharoplasty or fillers?

You appear to be relatively young. A filler is temporary and is quick and should not have a complication. You are probably not ready for a mid facelift. When I do a blepharoplasty on lids like your I remove fat from the bulge and put it in the valley below. Without seeing you that is what I think you would want.

Toby Mayer, MD

7 reviews

Beverly Hills Facial Plastic Surgeon

www.bevhills.com

Lower lid surgery or filler for puffy lids?

Thank you for the photos. The angle of the camera makes your fat look worse than it actually is. I would recommend filler first (no downtime if one uses hyaluronic acid gel) or fat with minimal downtime. I would not remove fat from you lower eyelids, you already are exhibiting signs of hollowing out. The fillers are reversible (if you don't like them), not burning any bridges, maybe a few bucks, but surgery is more permanent.

Tear trough deformity

You appear to have a deep tear trough deformity that accentuates a mild lower lid pseudo-fat herniation. I would recommend to my patient to try diminishing the deformity with an HA filler first and if that sufficiently improved the appearance of the eyes, then it can be repeated with longer lasting fillers such as PLLA or Autologous Fat. Tear trough injections require extensive skill and experience. I would strongly recommend finding such a provider in your area if this is the option you... more

By photographing yourself looking up, you make your lower eyelid fullness look its worst.

EBH The advice of the oculoplastic surgeon you saw is probably sound. Unfortunately so often a surgeon offers you something because that is what they do, right or wrong. There is no question that for many people what they really need is not lower eyelid fat removal but lower eyelid hollow filling. The hollow develops do to deflation and ptosis of the cheek fat right at the top of the cheek. This helps restore a more youthful heart shape face. For some... more

Kenneth D. Steinsapir, MD

8 reviews

Los Angeles Oculoplastic Surgeon

In most cases, transconjuntival removal of the fat bags in your lower eyelids will solve the problem.

It appears that you have prominent fat pads in the lower eyelids. These can be removed or repositioned. After surgery, If the tear troughs still appear hollow one month after surgery, I would recommend a filler such as Restylane. In my experience, most patients do not need the filler if the bags are removed.

Mark Taylor, MD

Salt Lake City Dermatologic Surgeon

www.gatewaylasercenter.com

Lower eyelid surgery

A very common aging change in the lower eyelids is the development of 'bags', which are in most cases due to an outward bulging of the fat pads behind the lower lids. These 'bags' of fat can be improved by conservative removal through an invisible incision on the inside of the lower lid (trans-conjunctival approach) in patients that do not require skin excision, or through the under-eyelash (sub-ciliary approach) in patients that are having some excess lower lid skin removed... more

Michael Law, MD

17 reviews

Raleigh-Durham Plastic Surgeon

michaellawmd.com

Lower lid fat transposition blepharoplasty

Although fillers have a definite role in helping dark circles. you are a candidate for lower blepharoplasty with fat transposition, meaning the fatty buldge is moved down to the hollow area. See another oculoplastic surgeon. Dr Taban

Treatment of the tear trough

It is clear from your photos that you do not need and should not have tissue removed. You are assuming that blepharoplasty surgery means tissue is removed. Althought that was the case 20 or 30 years ago that is no longer the case. The surgery can also be done to repositiion tissues within the eyelid without removing any of them. The desired look is to soften the junction between the lower eyelid and cheek so it is less noticeable and smoother. This can be done by joing the eyelid fat to... more

Fillers are great, but lower eyelid blepharoplasty has greater longevity.

Hi, Although I am a huge advocate of the use of Radiesse to reestablish the roundness of the cheeks and the fullness between the upper cheek and the lower eyelid which will have the wonderful benefit of blunting the fat hernia, I believe your best choice would be a blepharoplasty. I do both procedures in all aged individuals. In your case, I would recommend a lower eyelid blepharoplasty. Your skin tone is excellent and your face appears very young. The Radiesse is... more

Filler or Lower Blepharoplasty for Lower Lids?

From the photos, you have fat bags of the lower eyelids. Fillers can soften the leading edges of the fat bags but will add volume to the area. Lower eyelid surgery will remove the bags with a 30 minute surgery without visible incisions. One is an office treatment, the other a short surgery. Fillers treat the symptom and surgery removes the problem. Each have their benefits.

Lower Eyelid Bag Treatment with Filler or Surgery

Thank you for your question. Lower eyelid bag treatment is a common request for plastic surgeons. Generally, two options are available: injections or cosmetic surgery. For most younger patients, facial injections with a hyaluronic acid filler such as Restylane help rejuvenate the area. Traditionally for older patients, cosmetic surgery to help reduce fat bulges and excess skin is required. Age alone, however, does not determine the best option. Only after a comprehensive evaluation... more

You would get good result with surgery

You have herniated fat and mid face deficiency. I would recommend lower eyelid surgery and tear trough implants. You can check my web site for examples.

Kamran Khoobehi, MD

28 reviews

New Orleans Plastic Surgeon

Fillers vs. lower lid blepharoplasty

Your photos disclose excess fat bulging in the lower lid with very good smooth overlying skin and muscle. Using a filler below the bulging fat (the tear trough) will only make your lower lids appear more puffy. From your photos you appear to be an excellent candidate for a transconjunctival blepharoplasty, which would leave you with no visible scars.