Lower Bleph or CO2 Laser for under eyes, or is fat transfer enough? (Photos)

Thank you for your question. Fat transfer has gained popularity as a solution for under-eye hollows and midface volume loss, but it carries significant risks. One major concern is its potential to permanently disrupt the natural movement and "gliding" function of the lower eyelid and upper cheek. This area can redistribute and "heaping" gracefully when you smile. This natural movement can be irreversibly compromised once altered, especially by fat grafting or resurfacing treatments. Even non-surgical procedures like laser and radiofrequency treatments can harm this gliding plane, resulting in a stiff or unnatural appearance when smiling. While non-ablative treatments, such as Clear + Brilliant, are gentler, they typically provide modest results.

I see 3 to 5 new consults each week from individuals who were persuaded to have free fat grafts to their under eye hollows and top of cheek area. Generally the are concerned with the irregularity that is created but overwhelmingly the other issue that troubles them is that the way that the upper cheek and lower eyelid heap up when they smile was altered by the procedure. Removing lumps of scared fat in the lower eyelid is not straight forward but not impossible. Restoring the way the smile lines heap up is clearly impossible. Your unoperated lower eyelid and cheek possess an amazing internal gliding ability. the natural, unaltered layers possess an amazing gliding ability that handles and redistributes the skin of this area to beautifully handle how this tissue heaps when we smile. Once this tissue is messed with, that heaping characteristic is forever altered and unfixable. You will not realizing the cosmetic benefit you are hoping for. Even laser resurfacing and radio frequency treatment have the ability damage this glide function. Loss of this gliding function can not be recovered. Likely non ablative services (e.g. Clear and Brilliant) is less likely to be associated with the "gumming" up of the glide function but they are also very modest in what they can accomplish. In terms of the slight loss of volume in the under eye circle area, hyaluronic filler Restylane is probably the best of the services for helping this area but you are asking for some one to sculpt your tear trough. Very few injectors are fussy enough to do these services. Please exercise caution out there so you are not harmed and heart broken.

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin - Winnetka & Chicago. This is a great question. CO2 laser can be a great starting point, especially if fine lines and wrinkles around your eyes are a major concern. It works by resurfacing the skin, stimulating collagen production, and tightening the delicate under-eye area, which can soften the appearance of wrinkles and crepiness. Since you've had hollowing and wrinkling since childhood, the issue may be both structural (lack of volume) and skin quality-related—so while laser won’t add volume, it can definitely improve the texture and firmness of the skin, making the area look smoother and more refreshed. That said, if there's a significant degree of hollowness or shadowing that laser alone can't fix, fat transfer can be a smart complement. It’s particularly useful for someone like you who has long-standing volume deficiency, as it can restore fullness to the tear troughs and upper cheek area, creating better support under the eyes and improving how light reflects off your face. When done carefully, it can make the under-eye area look less sunken and reduce that tired appearance. Blepharoplasty (eyelid surgery) is more appropriate if you have excess skin, significant under-eye bags, or true fat herniation. I hope this helps and best of luck!