I'm considering lower bleph for bags under my eyes; am also interested in voluma filler for facial volume loss.

which procedure should come first? Can they be done at the same time?

Doctor Answers 14

Lower eyelid surgery and filler

It always helps to see photos, but in general I would say if your are considering lower eyelid surgery you should consider fat grating to the cheeks at the same time.  Fat, when done by an experienced plastic surgeon, can not only augment the cheek area but soften the line or trough between the lower lid and cheek where fat has descended and been lost.  Many surgeons though use the fat of the lower lid to soften this area during surgery and will use filler like voluma after if necessary.  Fat , however, is permanent and fillers are not.  Fat grafting does not add significantly to the recovery although there may be a bit more bruising.

There are many options for lower lid surgery and the decision on what is best should be discussed with your plastic surgeon. 

Wilmington Plastic Surgeon
5.0 out of 5 stars 24 reviews

Lower Blephs

Hi Neomag

Thanks for your question. We are getting great results for our lower bleph procedures.

Lower eyelid surgery aims to address the bags under the eyes. Excess skin and removal or reshaping of the fat smooth’s the contour between the lower eyelid and the cheeks. Your cosmetic surgeon will assess if the procedure can be performed under local anaesthetic.

There is a very wide range of products currently available and the most usual component in modern wrinkle fillers is hyaluronic acid. This substance is found naturally in almost all body tissues. When injected as a filler, it is immediately effective in correcting creases and is slowly absorbed over 6-12 months. Earlier generations of fillers used collagen which was purified from animal tissue and these caused allergic reactions in some patients. Allergic reaction is a rare complication with the modern generation of hyaluronic acid fillers.

There should be no problem getting them done at the same time but this would be subject to consult. All the best

Under Eye Bags May Be Improved Nonsurgically Using Injectable Volumizers & Fillers

Without photos, it is difficult to comment in more than in the most general fashion. However, nowadays, fillers are routinely used successfully to improve many kinds of under eye (infraorbital) bags, dark circles and crinkles.

Since age-related loss facial volume in the cheek area contributes greatly to the development of the under eye problems mentioned above, it would be wise to have this area treated first with volumizing fillers to provide the necessary overall support and projection to this region and then afterward to treat the infraorbital bags directly as needed. (Both areas can and often are easily treated in one treatment session it's the order of the treatment that is especially important).

In my Upper East Side Manhattan practice, I typically use Voluma XC and Restylane Lyft for the nonsurgical cheek augmentation and Belotero Balance for the under eye regions (since this product possesses little to no tendency to give rise to the unwanted, bluish Tyndall Effect when injected superficially within the especially delicate tissues of this region). In my Israel satellite facility where a far greater number of regulatory agency approved fillers and volumizers are available, I would opt for Stylage XXL, Emervel Volume and Hyaluronica 2 for the cheeks and Teosyal Redensity II for the under eye areas.

Best to seek consultation with a board certified aesthetic physician with experience and expertise in injecting these regions and to avoid novice injectors trained in simply treating smile lines. Make sure to ask to see his/her before and after photos of both the cheeks and the eye bags regions.

Nelson Lee Novick, MD
New York Dermatologic Surgeon
4.8 out of 5 stars 22 reviews

I'm considering lower bleph for bags under my eyes; am also interested in voluma filler for facial volume loss.

Thank you for your question.  If you're going under anesthesia for lower blepharoplasty, you may want to consider fat transfer at the same time for your facial volume loss.  Be sure that you consult with an experienced plastic surgeon, certified by the American Board of Plastic Surgery.  Good luck!

Zachary Farris, MD, FACS
Dallas Plastic Surgeon
5.0 out of 5 stars 14 reviews

Bleph and facial fillers

Certainly they can be done at the same time provided that the filler is not placed in the same area as the bleph.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

I'm considering lower bleph for bags under my eyes; am also interested in voluma filler for facial volume loss

If you are a candidate for lower blepharoplasty- then I would recommend having that along with a fat transfer. But without photos and the benefit of physical exam- it's difficult to comment accurately re/what you are a candidate for. 

Lower lid blepharoplasty and Voluma

My personal preference is to perform the surgery first, wait for all the swelling to resolve, then finish with the filler. The eyelid surgery will greatly improve the eyelid / cheek junction. Once the eyelid surgery has recovered, we can then reassess and treat the remaining issues with the Voluma. Voluma should have very little if any downtime, so there is really no advantage to doing them together. The combination should be a "home run".

Andrew Campbell, M.D.
Facial Plastic Specialist
Quintessa Aesthetic Centers

Andrew Campbell, MD
Milwaukee Facial Plastic Surgeon
4.7 out of 5 stars 26 reviews

Lower lid blepharoplasty for under eye bags

 The primary goal for lower blepharoplasty is to remove the fatty deposits underneath the lower lids causing the puffy look. The fatty deposits are removed from the inside of the eyelid, also known as a trans-conjunctival approach.
 To accomplish augmenting the midface due to facial volume loss, fillers can be used  on a temporary basis,  while cheek implants are used for more permanent augmentation. For many examples of lower blepharoplasty and cheek implants, please see link and the video below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 126 reviews

Lower lids

Neomag, for the problem you describe but cannot see I would normally perform a "SOOF lift blepharoplasty". Search the Internet for more information and for a specialist near you who is familiar with this approach. Good luck!

M. Sean Freeman, MD
Charlotte Facial Plastic Surgeon
4.8 out of 5 stars 44 reviews

Lower Lid Bags, Voume Replacement

Whether you are having the volume in the malar area, the eyelid or the other parts of the face since you are considering an eyelid surgery you may as well consider having fat injected in the other areas instead of filler for a more lasting and more gratifying outcome.

Bahman Guyuron, MD
Cleveland Plastic Surgeon
4.8 out of 5 stars 20 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.