Lower Transconjunctival Bleph +/- Filler? Second Opinion? (photo)

I am 35 and am bothered by lower eyelid puffiness. More often, I am having people tell me I look tired when I've had a full night's sleep. I have talked to an oculoplastics surgeon who recommended removal of the lower medial fat pads only. I am concerned this will result in a hollow underneath my eyes as I age. Should wait to have a transcutanous bleph and just have filler done in the mid cheek area to smooth out this puffiness or have it done now to prevent more sagging of the undereye area?

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7 Doctor Answers | Asked by eyepuff

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Re-position of Lower lid fat pads prevents later hollowing

From the limited photos you provided you have two options that I would recommend. 1. Transconjunctival fat pad adjustment either with a conservative removal or releasing the restraining membrane (arcus marginalis) and allowing the fat pad to be redistributed to blend in with your cheek fat. If done conservatively I do not think you would be at increased risk for any abnormal hollowing. 2. Use of fillers beneath the fat pad to camouflage the bulging fat (this would only be temporary... more

Lower Blepharoplasty

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

Treatment of tear troughs

I think you could get what you want from just placing a filler in the groove or trough. You will need to discuss which filler with your surgeon. I think if you just take out the fat you will end up skeletonizing the area leaving you with a hollowed out appearance. My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a... more

Lower eyelid transconjunctival blepharoplasty with fat augmentation.

Lower eyelid transconjunctival blepharoplasty with fat augmentation will kill 2 birds with one stone. The fat is removed from the "mountain" and placed next to the bone in the "valley". No fillers or secondary procedure. See an experienced surgeon who is familiar with this technique so you do not end up with bumps!

Toby Mayer, MD

7 reviews

Beverly Hills Facial Plastic Surgeon

www.bevhills.com

Sylouette Threadlift, Cheek Implants, Minilift Vs. Threadlift. What is Better for my Nasolabial Folds?

Thanks for the photo. I would first do the transconj including 2 of the 3 fat compartments. Allow 2 to 3 months healing than use a filler if needed.

TC Bleph

A transconjunctival bleph is usually the best for young patients with lower eyelid fat. I do not like fillers in the lower lids, removing the fat is usually the best treatment.

Please post better photo.

From the photo you posted, it seems to me that using fillers or fat grafting would give you a more natural result right now. Photo does not replace the need for a good hands on exam, and it may be your surgeon is correct, and that I will come to the same conclusion if I examined you in person. Get a second opinion. Not all surgeons are comfortable with fillers. An ASOPRS trained Oculoplastics surgeon near you is available on ASOPRS dot org.