I have deep set eyes, I want to remove my fine lines and extra skin, would fillers or eyelid surgery be my best option? (Photos)

Question

I have deep set eyes, with fine lines and wrinkles under my eye.. I also feel like there some extra skin on the top of my eyes.. will fillers be the best way to go or the eye lid surgery?

Raffy Karamanoukian, MD, FACS · Answer

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser.  Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.  
Best,
Dr. Karamanoukian 
Realself100 Surgeon

Jason Emer, MD · Answer

"I suggest reaching out to an expert for a formal consultation. I like to recommend my patients start a combination of facial rejuvenation treatments.

1) Skincare with products and microneedling/PRP
2) PDT Light Therapy a few times per month with growth factors
3) Laser treatments like Clear + Brilliant regularly and others (Fraxel, Moxi, Viva, CO2, Erbium, Halo) a few times per year
4) Sculptra injections a few times per year for collagen production with fillers like Juvederm, Restylane, Belotero, Radiesse, and/or Bellafill
5) Thermage/Ultherapy for yearly skin tightening with or without PDO or cone-based Instalift threads for lifting
6) Botox every 2 to 3 months to stop movement lines and prevent lines at rest

Best, Dr. Emer."

John J. Martin, Jr., MD · Answer

You have a deep tear trough.  Some HA filler placed into this will help to smooth out the lower lid.  It won't eliminate all the fine lines, but will help by adding volume.  will also help to decrease the appearance of a dark circle there.  It should last at least a year.  Make sure you go  to someone who does this regularly as it can be tricky.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation.  Based on
your photographs, under eyelid fillers injected into your tear trough may be a good place for you to start.   Make sure you specifically look
at before and after pictures of real patients who have had this surgery
performed by your surgeon and evaluate their results.   The most
important aspect is to find a surgeon you are comfortable with. I recommend
that you seek consultation with a qualified board-certified plastic surgeon who
can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.  FACS
Harvard-trained plastic surgeon

Jeffrey H. Lee, MD · Answer

Hi and thanks for your question.  It doesn't look like you have much extra skin in your eyelids and you have to be very careful when thinking about removing skin as this can lead to your lower eyelids being pulled down.  You do have a tear trough deformity which is the valley between your eyes and nose.  Filler would be an option as well as surgery depending on your goals.  If anything, you have a lot of sun damage to your skin (and maybe fine lines that aren't apparant in the pictures).  You should start using a cream with retinol or get a prescription for retin-A cream as this will help the overall appearance of your skin.  After that, a peel or laser resurfacing would help a lot.  So between the tear trough and the sun damage to your skin, you should have a discussion with a surgeon to figure out what bothers you the most and what is the best course of action.  Good luck!

Ernest Layton, MD · Answer

Thank you for your question and photos.  As it is best to see you in person, from the photos you presented I would recommend fillers first.  See how you like them, then you can always do fat grafting in the cheek area to give you a more youthful appearance.  I like to use Voluma by Allergan.  Hope this helps.  Please see a Board Certified PS to treat you. 
Regards,Dr Ernie Layton

Kamran Khoobehi, MD · Answer

You can get great results with fillers or fat grafting. I would recommend fillers first and if you like the results do fat grafting.

Steven Wallach, MD · Answer

It looks like your tear trough region is pretty deep set. You might want to consider fillers to soften the area. Best to see you in person to be properly evaluated.

Ivan Vrcek, MD, FACS · Answer

Thank you for your question and photos. 
I do see the changes in your upper and lower eyelids that you are noticing. The lower eyelid changes are chiefly due to volume loss that is normal and occurs with age, although genetics can certainly play a role. Correcting this volume loss with either filler or fat transfer would be the best way to engender improvement in my opinion. The benefits of filler (for example Restylane) are that it is reversible, less expensive, and has minimal downtime. The downside of filler is that it is temporary--typically lasting about one year. Fat, on the other hand, is more permanent. Consider seeing an ASOPRS-trained oculoplastic surgeon in your area for a consultation. You might consider starting with filler, and if you like it, proceed with a more permanent solution like fat transfer.
For the upper eyelids, a conservative blepharoplasty to remove some of the extra skin and fullness would be a reasonable option.
Best of luck!

Richard O. Gregory, MD · Answer

The tear troughs are also called nasojugal  grooves and are related to the underlying orbicularis muscle. The  tear troughs which are exaggerated in this patient can be treated with injectable filler material including hyaluronic acid or fat.  There are risks with injection of this area and complications can be serious. You should go to a reputable, experienced injector and understand the risks before undertaking injection in the periorbital area.

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