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
Robert Singer, M.D., FACS
You can benefit from either filler injection to fill the hollowness ("dark circles") or possible from lower blepharoplasty with fat transposition where the fat/bulge is moved into the hollow area. See an oculoplastic specialist.
Lower eyelid bags can be made by a variety of tissue relationships. So without a physical examination, it would be hard to know if what you need is a lower blepharoplasty. For some people, that fullness could be caused by the bony orbital rim. Put your finger on the top of the bump. If it is soft, it is fat, if it is hard, then it is the bony rim. Obviously what makes the bump makes a difference regarding which surgery to perform. Fat, yes is nicely helped with an transconjunctival lower eyelid procedure where the fat is mobilized to fill the under eye hollow. This is called an acus marginalis release. Be aware, you could also have a lower eyelid filler with restylane and have the hollow filled without the need for surgery. This type of service lasts for about 1 year at a time.
Yes, you do have fat pockets in the lower eyes. This can be corrected with a lower blephroplasty. The incisions are made on the inside of the eyelid so there will be no incision on the outside of your eye.
Lower lid blepharoplasty with ffat transposition for tired looking eyes. Patients are extremely happy to have the excess fat placed in the tear trough. This can be done trans- conjunctively so you have no external scar. See a very experienced surgeon for this.
Thanks for the great photos. It looks like there is not a lot of lower lid skin excess, but prominent fad pads causing a deep shadowed groove (a tear trough) below the fat. Transposition of the fat into the tear trough would help, but you have such a negative vector that I might be more inclined to consider fat grafting. This is very tricky in the lower lid area so see someone experienced in the procedure if you want to explore that option.
Your lower lids show fat coming forward from the eye socket. This is common and can be repaired with a lower eyelid blepharoplasty with fat repositioning. The fat can be moved in to the tear trough, which will smooth out the transition between the lower eyelid and the cheek as well as fill in the dark area near the side of the nose.
You have some prolapsed orbital fat which creates a shadow over the tear trough so it looks dark. I would not remove this fat as it can make the area more hollow. You could have a fat repositioning surgery to move the fat down into the tear trough. However I don't think that you really look that bad - and some filler into the tear trough should help quite a bit and let you postpone surgery.
The photograph shows herniated fat pads in all 3 compartments of the lower lids. This is best addressed with a conservative fat removal through a trans-conjunctival approach on the inside of the lower lids. For many examples, please see the link below