What would the most effective under eye treatment: surgical, non-surgical and non-invasive? (photo)

I am 27 and my under eyes have progressively been getting worse; dark under eye circles, under eye bags, big blue veins and puffiness. Make up does not really help cover it and people constantly ask if I have black eyes or telling me I look like I haven't slept. I am getting married in 5 months and would like to see some decent results by then. Thank you!

Doctor Answers (6)

The most effective treatment for baggy lower eyelid

Based on your pictures, in my opinion, lower eyelid surgery, arcus marginalis release and fat redistribution would give the best aesthetic, long lasting, predictable and consistent outcome. This will correct both the bagginess and hollowness of the lid/cheek junction. 
New York Plastic Surgeon
4.5 out of 5 stars 23 reviews

Hualu-Blepharoplasty versus Surgery

A  transconjuctival lower eyelid blepharoplasty with release of the ligaments and preservation/redraping of the fat compartments over the bony structure is more indicative in your case. However hyaluronic acid filler injections are a conservative alternative that can improve the contour and camouflage to a certain extent the fat prolapse.  I would recommend a monophasic filler like Belotero as it has better distribution within the soft tissues. Even if you opt for a surgical approach, fillers might be still necessary to further refine the eyelid-check junction contour.

London Oculoplastic Surgeon
5.0 out of 5 stars 1 review

Lower lid options?

Fillers often can produce a nice temporary cosmetic improvement in some patients, but not all. They certainly do not achieve what a well performed blepharoplasty will do.

Fillers can help improve the cosmetic appearance but you will get only a temporary and limited improvement with them. A better and long standing correction would be achieved with a blepharoplasty of the lower lids: Conservatively removing any excess loose skin that may be present, contouring the bulging fat pads, which are generally inherited, unrelated to weight, and tend to protrude more with time, and smoothing the tear troughs with micro-fat grafts or fat repositioning.

Keep in mind that following advice from a surgeon on this or any other website who proposes to tell you exactly what to do based on two dimensional photos without examining you, physically feeling your tissue, assessing your desired outcome, taking a full medical history and discussing the pros and cons of each operative procedure would not be in your best surgery. I would suggest that you find a surgeon certified by the American Board of American Plastic Surgery and one who is ideally a member of The American Society for Aesthetic Plastic Surgery (ASAPS) that you trust and are comfortable with. You should discuss your concerns with that surgeon in person.

Robert Singer, M.D., FACS

La Jolla,California
La Jolla Plastic Surgeon
4.5 out of 5 stars 14 reviews

Lower eyelid bags

There appears to be a significant bulge of lower eyelid  fat prolapsing forward along with a depression at the eyelid-cheek junction. Therefore I would probably recommend a cosmetic lower eyelid blepharoplasty performed through the inside of the lower eyelid(called a transconjunctival blepharoplasty) followed in a few weeks after surgery by lower eyelid hyaluronic acid gel fillers like Belotero or Restylane to fill any depressions that may remain at the eyelid -cheek junction. 

Web reference: http://nj-cosmeticsurgery.com

Ridgewood Oculoplastic Surgeon
5.0 out of 5 stars 7 reviews

Options to treat lower eyelids

Your photos appear to show fat causing the puffiness under your eyes.  If this is the case, it could be improved surgically, with lower blepharoplasty or a filler could be injected under the bags to help camouflage them.  The result from surgery would be longer lasting and deal with the root of the issue whereas the filler would be temporary and improve the appearance by filling the depressions under the bags.  If you went with a filler, I would recommend one of the hyaluronic acid products.
San Francisco Facial Plastic Surgeon
5.0 out of 5 stars 13 reviews

The answer very much depends on your physical examination.

You look like you have the classic lower eyelid pillows.  Classically with was addressed with transconjunctival lower blepharoplasty.  More recently this has evolved into transconjunctival lower eyelid arcus marginalia release surgery where the lower eyelid fat is preserved and transferred as a living pedicle into the lower eyelid to fill the tear trough hollow.  The physical exam is very important because what looks like lower eyelid herniated fat may be the bony orbital rim, in which case you will be very disappointed with surgery.  Now having said that, if your skin quality is good, fillers are a very reasonable alternative to lower eyelid surgery.  This also reduced the pressure to have a surgery just months before your wedding.  Just remember that the filler service is a bit fussy so you need to find the right injector and get this done now!  With the wedding so close, I recommend exploring the filler.

Web reference: http://www.lidlift.com/case-studies/eyelid-case-studies

Los Angeles Oculoplastic Surgeon
5.0 out of 5 stars 14 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.

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