Eyelid Surgery: Q&A

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What Is The Best Way to Remove Crease Under Eyes? (photo)

What is the best way to remove a crease under the eyes? Fillers? Fat transfer? Blepharoplasty? Skin pinch? I am 30 and ideally would like to add more fat to the area but am wondering if the line could ever be filled in or if I would need a more invasive procedure? Also, would an upper blepharoplasty be best to remove the hooding that is beginning to form in my upper eyelids or is this something that can be achieved with a fat transfer or filler to the brow?

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14 Doctor Answers | Asked by beemar in CA

Doctor Answers (14)
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Removing crease under the eyes

The crease that is present beneath the lower lids is due to shadow effects that are caused from herniation of the orbital fat pads. This is best addressed through a transconjunctival approach with a conservative removal of fat in both the middle and medial compartments of the lower lid. With respect to hooding of the upper lids, a small elliptical excision of excess skin can be removed from the upper lids to deepen the upper lid crease and remove excess fat in both the middle and... more

Lower eyelid crease and upper eyelid concern

Though it is impossible to give a definitive opinion without an examination in person, the photos you provided are quite helpful. The lower eyelid crease is a hollowness that is most likely hereditary or simply genetic in your case. It is due to lack or absence of fat in that area and needs filling to provide a smooth restful-looking transition between your lower eyelid and your cheek without the shadow it is currently creating. Fillers like Restylane or Juvederme Plus are preferable to... more

How to smooth lower eyelid creases

Your eyes/eyelids are very beautiful, and the first priority is to preserve all of the beautiful elements. The lower eyelid/cheek junction is a distraction from your beauty, and may be camouflaged by filler, nearly always my first choice for someone in your age group. Juvederm Ultra Plus or Perlane should work nicely, or perhaps Radiesse. Of course, in person examination, consultation, discussion of possible choices, risks, benefits, expected longevity, etc. should... more

Upper / Lower Eyelid surgery in a young patient

From your photos, it is difficult to assess what is necessary for your lower eyelids. It could be that you just have a small amount of fat excess creating your bulges / shadowing, and a transconjunctival bleph is all that is necessary. I do not think you have any lower eyelid skin excess. Other possibilities are that you have strongly adherent skin to the lower orbit (creating the naso-jugal trough), and that an arcus release is necessary. Additionally, you could have... more

Best Way to Remove Creases Under Eyes

Under eye creases can optimally, depending on the age of the patient, be improved with filler and/or by skin pinch removal. If you have skin redundancy or if you have skin pinch then a lower eyelid blepharoplasty will work well in this area. For fine wrinkles, one can use laser resurfacing or a chemical peel.

Rod J. Rohrich, MD

10 reviews

Dallas Plastic Surgeon

What Is The Best Way to Remove Crease Under Eyes? (photo)

Many options or combination of options. Easiest is Restylane filler. Than Fat grafting, than transconj bleph., or a combination of these options. Always best to be seen in person by a boarded PSs in your area.

Eyelid rejuvenation

Your upper lids are best addressed with volume augmentation (filler injection). Your lower lids are probably best addressed the same way, although surgery may have a role. It is difficult to tell without closeup examination.

Best Way to Remove Crease Under Eyes?

Frankly, I think you have almost perfect eyes. I think operating on your operating on your upper lid borders on the criminal. There is NO way the upper lid can be improved upon. The corners of the eyes are perfect with the side corner about 2 mm higher than the inner corner (canthus) the way a youthful eye should be. The almond shape is gorgeous. There is minimal sag of the lower lid with about 1mm of scleral (white) show. There is darker discoloration of the lower lid with a pronounced... more

What Is The Best Way to Remove Crease Under Eyes?

From the photos, it appears that you may have malar bags that should be evaluated by a plastic and cosmetic surgeon or occuloplastic surgeon before you consider having any fat transfer, fillers or surgery.

Tear trough

You have herniated orbital fat, more pronounced in the oictures on the right. You have a terar trough deformity. In your case the best approach is a lower lid blepheroplasty, and redistribution of the fat into the tear trough. As for the upper lids do not do any thing,you will end up with a hollow eye if you remove the skin (not attractive) Would have liked to see the entire face to see the cheecks and why the right fat is down to lid cheeck junction. Get an... more

Removing creases of lower eyelids.

I would need to see you in person to give you an honest answer. I think your fat in your lower lids is excessive and also may extend into your cheek. No fillers since you already look very "puffy". Nothing for your beautiful upper lids!! Leave them alone for now.

Toby Mayer, MD

7 reviews

Beverly Hills Facial Plastic Surgeon

www.bevhills.com

Hollow eyes and cheek

Thanks for sending photos. It is clear from these photos that you have a deficiency of volume (fat) in the periorbital region. This includes the upper orbital area, the lower orbital, and the cheeks- eyelid junction. Given your age (30), this is a genetic issue and likely unrelated to aging. You probably have always had this to some degree, even as a teenager. Most people with this problem are often told they look tired even if they are well rested. The... more

Amir M. Karam, MD

62 reviews

San Diego Facial Plastic Surgeon

www.drkaram.com

Filler the best solution for now

All of the typical aging changes in your eyelids are starting to show. The trick is to pick the most practical solution for now. Despite the small amount of bulging fat in the lower lids, it is too early for lower eyelidplasty based on the pictures you sent. Restylane in the lower lid can provide a good measure of correction with typically a year or more of durability in this location. A little bruising is common after the treatment so plan a time when this will not... more

Do not have surgery for this.

What is going on is that you are missing deep buccal fat at that normal supports this area. The crease is called a midcheek groove. It is best addressed non surgically with Restylane. The area needs to be filled. The treatment is likely to help you for well over a year, perhaps two years. This groove will change over time which is why a more permanent solution like a fat transfer is not ideal.