What can I do about my lower eyelids? (photos)

My lower eylids are puffy and I want to get rid of the puffiness. What can be done, should I get Fillers or should I have Surgery? Thank for your Help!!!!!!

Doctor Answers 12

Puffy Lower Eyelids

Your appearance is very typical of the aging lower eyelid. The fat within your eye is no longer well contained and is protruding forward, causing puffiness or "bags" under the lower eyelid. You also have age-related fat loss in the upper cheek and at the corners of the eye. These changes result in an uneven contour of  "hills and valleys", which is not youthful. There are many surgical and non-surgical methods that can be used to improve your appearance. I think the best result combines surgery (to reduce or redistribute the fat bags under your eyes) and injections of fat (or filler) to correct the areas of volume loss or deflation. If you are not ready for surgery, you can achieve a nice improvement with fat or filler alone.  Best of luck.

Saint Louis Facial Plastic Surgeon
5.0 out of 5 stars 96 reviews

Lower eyelids surgery candidate to address puffy eyes

You are a good candidate for lower blepharoplasty. Fillers would not be good option for under your eyes, but you may want to balance your face with voluma injected into the cheeks to address the volume loss.

Kris M. Reddy, MD, FACS
West Palm Beach Plastic Surgeon
4.5 out of 5 stars 36 reviews

Lower eyelid bags- filler vs surgery

On your photo, I can see that you have a combination of volume loss in your lower eyelid/cheek area as well as protruding fat bags in the lower eyelid. You would do well, with lower eyelid surgery to remove the fat bags, and adding some filler in the cheek area. There are pros and cons of each procedure.

If you look on my real self profile you will see some befores and afters of two patients with lower eyelid problems, one male treated with surgery (his bags were bigger than yours) and the other is a female patient treated with filler and lower eyelid laser. Similar problems treated with different options, both with great results. A consultation with a plastic surgeon with lots of experience in this area will be your best option to explain what would be best for you. Good Luck!

Dilip D. Madnani, MD, FACS
New York Facial Plastic Surgeon
4.8 out of 5 stars 73 reviews

Lower eye lid surgery for puffy eyelids

The photograph demonstrates herniated fat through the orbital septum in all 3 compartments of both lower lids.  To rejuvenate the lower lids, a conservative amount of fat is removed from the inside of the eyelid, also known as a transconjunctival approach. When excess skin is present, a incision is made on the outside of the eyelids directly below the eyelashes to pinch the excess skin.  In our practice, this incision is closed with tissue glue. For many examples and more information, please see the link below

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

What can I do for lower lid bag?

You are a perfect candidate for lower lid blepharoplasty!  The surgery is designed for this specific problem.  When the bags get too big like yours, the filler placed to attempt to camouflage just leads to bigger bags.  Filler would not help this, but the good news is surgery will fix it for good!

Katrinka L. Heher, MD
Boston Oculoplastic Surgeon
5.0 out of 5 stars 7 reviews

What can I do about my lower eyelids?

Thanks for your question and photo. It looks like you have lower lid fat pads that would be very amenable to a surgical lower lid blepharoplasty. This surgery may be sufficient to achieve a more rested look and is associated with a fairly short and easy recovery (usually about one week out of work. You also have some cheek volume deficiency (the "valleys" below the "mountains" of puffy fat) that could benefit from filler injection or fat grafting at the time of surgery to make the lid-cheek junction more youthful.
Be sure and consult with an experienced board certified plastic surgeon, facial plastic surgeon or oculoplastic surgeon (or two) to learn your options. Best wishes.

Kevin L. Smith, MD, FACS
Charlotte Plastic Surgeon
4.9 out of 5 stars 38 reviews


From these photos, it looks like you would get a homerun result with a lower lid a TC blepharoplasty. In my experience the most important thing in assuring a quick recovery from blepharoplasty is minimizing bruising and swelling. Bruising is much easier to prevent that to get rid of. I have all my patients ice as much as possible from the time they get home until they go to sleep that first night. And I instruct them to not recline any more than 45 degrees until they go to sleep that night. And stay away from salt. Patients who follow these instructions generally heal very quickly with little or minimal bruising or swelling. Good luck, Dean Vistnes.

M. Dean Vistnes, MD
Bay Area Plastic Surgeon
5.0 out of 5 stars 40 reviews

Treatment of Puffiness of the Lower Eyelid.

What you have is classic changes of aging of the lower eyelids. This can be treated with either injectables like fat or a heavy filler like Juvederm Voluma or Radiesse or by surgery. Each has its own risks and complications and benefits. See an experienced plastic surgeon in both surgical and nonsurgical eyelid rejuvenation and discuss this at length. 

Robert T. Buchanan, MD
Highlands Plastic Surgeon
5.0 out of 5 stars 5 reviews

Lower eyelid puffiness

 It looks to me like you have some fat bulging in the lower lids and a loss of volume in the upper cheeks.  I would likely remove some lower lid fat and graft fat into the upper cheeks.

What can I do about my lower eyelids?

Most expert experienced artistic plastic surgeons have a variety of procedures, both non-surgical and surgical, at their disposal to produce excellent cosmetic results in the appropriately selected patient: Botox or Dysport, temporary hyaluronic acid fillers like Restylane, long-lasting micro-fat grafts, blepharoplasties, or combinations of procedures. Each has benefits and drawbacks and depends on desired outcome and individual anatomy.

In a patient with your inherited anatomy, a blepharoplasty will produce the best and longest lasting cosmetic result. 

Following the advice of anyone who would presume to tell you what to do without seeing photos and without taking a full medical history, examining you, feeling and assessing your tissue tone, discussing your desired outcome and fully informing you about the pros and cons of each option would not be in your best interest. Find a plastic surgeon that you are comfortable with and one that you trust and listen to his or her advice. The surgeon should be certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS). You should discuss your concerns with that surgeon in person.

Robert Singer, MD FACS

La Jolla, California

Robert Singer, MD
La Jolla Plastic Surgeon
4.6 out of 5 stars 19 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.