Your pictures really make this a clear cut call. You will definitely benefit with a very conservative but effective release of the fat pad. This would allow moving attached fat with great success for long term filling of the tear trough. This is a fat transposition that takes advantage of your own fat for transfer into the correct position. The best part in your case is that you can do all of this through in internally placed transconjunctIval incision.
I really find restylane or other fillers can be so helpful in the tear trough if the majority of the problem is related to volume deficiency- not your case.
We are moving more toward fat conservation and avoidance of disturbing the muscle flap of the lower eyelid. This surgery takes advantage of both.
Best of luck.
As you know lower lid transconjunctival blepharoplasty surgery removes excess fat. Lower eyelid Restylane replaces lost cheek fat that is right below the bag that you see. One lowers the hill and the other raises the valley. The key is figuring out which treatment will give you the best result. Some patients, depending on their anatomy, do much better with one or the other. I agree that in your case there is a choice. All things being equal (which there not- filler does not involve surgery, but will need to be repeated eventually) I think that you are a better candidate for surgery. The key is that the fat removal should be done very conservatively do that you are not hollow.
It is important to realize that while either approach can make you look great, neither is as good as what your finger can produce when you pull up your eyelid.
I would agree with your plastic surgeon. Filler is a nice temporary option for younger patients such as yourself. It is temporary but results can last up to one year or longer. The filler is placed below the "bag" to camouflage the hollows whereas surgery would actually remove the fat causing the lower eyelid bag. It would be reasonably to try undereye filler to see if you're happy with the results. If you don't like the idea of a temporary fix, then a transconjunctivalunctival lower blepharoplasty could be performed. I think that what you demonstrate by lifting up on your lid is probably a more dramatic change than you would see with this procedure. However, a blepharoplasty should create a significant improvement in the lower eyelid bags. I hope this information is helpful.
Stephen Weber MD, FACS
Denver Facial Plastic Surgeon
Thank you for providing such good pictures that really show the problem. Fillers such as Beletero and Restylane might minimize but not complely correct the problem, and while filling the area is a simpler approach I think ultimately you would not be happy, because you would still have some puffiness there from the herniated and malpositioned fat pad. A transconjunctival blepharoplasty that conserves and repositions your fat pad is the best option.
It is difficult to assess from the photograph but it appears than even though you are quite young you may benefit most for a blepharoplasty where a plastic surgeon removes the fat pads from under the area. Injections of Restylane or Belotero can temporarily hide some problems in the under eye area as well. Please find a board certified physician and get two opinions before proceeding with surgery that is permanent.
In your case, transconjuctival blepharoplasty with fat repositioning is the best long-term treatment option. In the technique, the existing bulge/fat is moved into lower position to fill the hollow area. See an oculoplastic surgeon.
In general, bags under the eyes can be improved with either lower blepharoplasty or fillers. The surgical option will address the fat causing the bags, and the filler option will camouflage the bags by filling in the hollow area beneath the bags. Blepharoplasty is a more long term solution than fillers.