Are there nonsurgical options that can serve as an alternative to lower blepharoplasty? Interest in correcting hollow under eyes

Question

I would like to know if there is a non surgical option for lower blepharoplasty to get rid of hollow under-eyes that have deep groove lines and I would like to ask does the surgical lower blepharoplasty give visible scars? and how many days is the healing process?

Paige Kennedy, MD · Answer

Hello and thank you for your question. Correction of lower eyelid concerns include both surgical and nonsurgical approaches. The ideal approach depends on your specific anatomy. Correcting under eye hollowing, or an orbital groove, can be performed nonsurgically with dermal filler, or surgically via approaches such as fat grafting or fat repositioning. Regarding scarring, there are approaches to the lower eyelids that involve incisions hidden on the interior of the lower eyelid (transconjunctival approach), as well as external approaches that will result in subtle external scars near the lower lash line. Recovery typically involves 1-2 weeks of downtime, in which swelling and bruising will vary. Activity will likely be limited by your surgeon for various amounts of time depending on the intervention performed. I recommend an in office evaluation where you and your provider can determine the treatment option that is best for you.

Selcuk Inanli, MD · Answer

Hello! Thank you for your question.Without the photo it is difficult to make proper evaluation. If you can provide photos with better lighting, from the side of your face and 1 meter away I would be able to make a proper evaluation. If you have hollow under eye area and no extra skin I would not recommend you a lower eyelid blepharoplasty. Fat injection might be an option for you. However, If you have extra saggy skin (and you are suitable) with the transconjunctival lower eyelid blepharoplasty you do not have any scar under your eyes. The healing process is due to your skin and body I cannot give any exact date for the healing. With the face-to-face consultation proper decision can be make.Best Regards!

Nima Shemirani, MD · Answer

Hi @SSS201! It is difficult to recommend a treatment plan for you without photos or in an person examination. That being said, hyaluronic acid dermal filler injections are an excellent non-surgical option to treat the tear trough area. The upper cheek is a major support for the under eyes. So when there is volume loss there, not only do the cheeks reflect this, but the under eye can as well with the development of tear trough and under eye hollows. I recommend seeking treatments from expert injectors who have the skill and experience to precisely inject fillers into treatment areas and avoid risks and complications.

Jonathan Kulbersh, MD · Answer

Thank you for your question. Dermal filler injections are an excellent non-surgical option to treat the area you’re referring to. These hyaluronic acid formulas can diminish under-eye circles by filling in hollow areas and creating a smooth transition between the lower eyelid and the upper cheek area. Keep in mind that while filler treatments are not surgery, they do require a great deal of skill and precision to achieve the best possible results. Using a microcannula to inject this area can minimize bruising and swelling while ensuring the smoothest outcome. I recommend scheduling an in-person consultation with an experienced, board-certified injector who can discuss your aesthetic goals with you and help you decide on the best treatment option.

Jason Emer, MD · Answer

At home peels like cosmelan, enlighten and aerify along with dermarolling (MTS roller with anteage MD ampules) should be started now. There are many things you can do to treat under eye hollows and dark circles. A surgical option to remove skin and/or fat will such as lower eyelid blepharoplasty with or without fat pad repositioning will be the best long term. There are many things you can do to treat under eye hollows and dark circles without surgery. Non invasive less downtime options such as fillers (Belotero, Juvederm Volbella​), lasers (Moxi/Halo/Fraxel/CO2​), Renuvion (J-Plasma), microneedling/PRP, stem cells and microneedling RF like Fractora PiXel8 or Morpheus can all help give some improvement. Accutite can often be used or stronger lasers like erbium or co2 spot treatment can tighten the skin and give very quick improvement in wrinkles and texture. A surgical option to remove skin and/or fat might be the best solution long-term. I suggest you get a formal consultation to see what is best for you and your goals. Best, Dr. Emer.

Stanley Okoro, MD · Answer

Thanks for your question. It is difficult to recommend a treatment plan for without photos or examining you in person. Make sure you consult with a board certified plastic surgeon to discuss your options for tear trough. In general, there are many options to help with lower eyelid hollowing. The most common treatment is filler, however there is a risk of post injection swelling/fluid accumulation. It help safe guard against post injection swelling to the area, I would consider a Y Lift certified injector. Filler is placed deep on top of the bone to enhance your natural bone structure. Good Luck

James R. Gordon, MD, FACS, FAAO · Answer

Thank you for sharing your question. If the puffiness is mild, then filers can be used to camouflage the bags. If the puffiness is too significant then only blepharoplasty will help. The scars are usuallly insignificant if there are any. See an experienced oculoplastic surgeon for consultation.
Good luck,

Harold J. Kaplan, MD · Answer

Hello SSS.  Yes, there are non-surgical options, but without photos, it's difficult to tell whether you would be a good candidate or not.  We use laser resurfacing to tighten the skin under the eyes and Restylane (see photos) to add volume for hollowing.  Both work well with the right candidates.

Kenneth D. Steinsapir, MD · Answer

Transconjunctival lower eyelid surgery is still surgery. There are many nonsurgical options but they need to be matched up to your issues. This included the use of under eye fillers, which for the right individual, can produce results that are better then surgery. This can be combined with treatment like a mild chemical peel that can firm the lower eyelid skin. You most definitely do not want surgery unless that is your only option. You did not provide a photograph to be more specific. Ultimately, there is not substitute for a detailed in person consultation. Your eyes can be your best feature.

Nelson Lee Novick, MD · Answer

Fillers have been used for many decades already to nonsurgically treat infraorbital hollows and tear troughs. I personally have been doing so since the early 1990s when the original collagen filler Zyderm was used for this purpose. More recently we have a number of excellent, natural cohesive, low viscosity HA fillers for this purpose. Filler treatment of the under-eyes requires extensive training and experience. It should not be left to the hands of novice injectors and cut-rate medspa venues. You would be wise to seek consultation and treatment by a board certified cosmetic dermatologist and be sure to ask to see his/her personal before and after photos before agreeing to proceed.  Best of luck.

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