Bleph or Fillers For Dark Circles, Fine Lines and Puffiness Under Eyes? (photo)

I am seriously considering a consult for Blepharplasty this week after years of HATING my under eye area. I have circles and fine wrinkles and puffyness. I am 34 years old. I was hoping to get opinions to see if I am a better candidate for surgery or fillers. I would prefer surgery (more permanent result) if that is an option, over fillers.

Doctor Answers 8

I Would Suggest Conservative Treatment

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At 34 years old and the picture you have supplied, you are beginning to show early signs of aging.  I have the philosophy if you can get a great results without going to the operating room, then I will recommend it.  A blepharoplasty is surgery to improve either the upper or lower eyelid area.  In your case, you would benefit more from:

1)  fillers for the tear trough/cheeks

2)  Chemical peel or lasers for fine lines

3)  Continue medical grade skin care for eyelid skin to prevent further aging

At your stage, I do not think a blepharoplasty would be worth the risk.


I hope this helps.

Lower eyelid surgery for dark circles

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Based on your photo it does not seem like you need much. I would have to look at you in person to tell for sure, but it appears you may do ok with tissue fillers for a while until you really need surgery. Both should be done with care. If you have never done tissue fillers before it may not be a bad idea to try it once. If you like it so much the better, if you don't you can proceed with surgery.

Saeed Marefat, MD
Washington DC Plastic Surgeon
5.0 out of 5 stars 31 reviews

Lower eyelid circles

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Moring Paige,

Let me tell ya' something.  I loooooooooove surgery. . .but I don't think I'd perform any one you just right now.  You could do well with fillers in the deep part of your tear trough but be concervative, the filler material used in this area can show a bit if its too much.  Those little bags you have when you smile are muscle, you could trim that during surgery but, again, no knives for now.

Here's my plan for you:

1.  A little filler in your tear trough

2.  Platelet rich plasma in the same area and just under the skin.  This is your own blood purified and injected leaving a nice layer of your own collagen.  Makes the skin smoother and gives it a more youthful turgor/thickness.  You can repeat this 2 to 3 times a year.

3.  Then do a little CO2 or Affirm or erbium laser over the top.  Be mild to moderate with.

You're looking at about 3 to 4 days down time.  Do it on a Wednesday/Thursday, you're ready by Monday so long as you don't over do the laser work.

You're gonna look awesome!

Chase Lay, MD

Chase Lay, MD
Bay Area Facial Plastic Surgeon
4.9 out of 5 stars 76 reviews

Dark circles in 34 year old

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You are a candidate for either fillers or surgery as long as each is done conservatively.  If surgery is done, then the existing lower lid fat pockets should be preserved and transposed in to lower position to fill-in the dark circles.  Consult an oculoplastic surgeon.

Not the best photo for this.

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At age 34 it is improbable that you need lower eyelid surgery.  Properly done, the under eye fillers are amazing and can last well over a year.  These have proven to be even more versatile than lower eyelid surgery.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Fine lines and puffiness under the eyes

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I suggest you speak with a Board Certified Plastic Surgeon to have him or her evaluate your eyelids and truly tell you if you are an appropriate surgical candidate.  Younger patients like yourself who describe your same concerns usually do well initally with non surgical treatments. These would include laser resurfacing (ablative and/or non ablative) as well as topical treaments that decrease swelling (these often contain caffeine). Surgery could certainly be the most appropriate treatment but appropriate pre-evaluation is needed. Best of luck. 

Puffy lower lids

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I don't see you as a surgical candidate at this point. You are very young and the photos aren't demonstrating excess skin in the lower lids, which would be the indication for surgery. Whenever patients come in with reports of puffiness, I suggest that they see an ENT or allergist to assess whether allergic rhinitis or sinusitis is contributing to those circles. It's always worth considering this to see whether management of allergies will improve the cosmetic appearance of your face.

Puffy, dark lower lids

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It's difficult to tell from the one photo how much laxity there is in your lower lids.  If the main problem is fine wrinkling and dark color, laser resurfacing could be the best answer,  This would be true even with a small amount of skin laxity.  I usually don't recommend fat removal, unless there is a significant excess.

Michael Leff, MD (retired)
Bellevue Plastic Surgeon

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.