Blepharoplasty or Filler? (photo)

I am a 28-year old Indian female w/ asymmetric drooping upper eyelids, dark undereye circles, and fine lines under eye. Will an upper and lower blepharoplasty cure all concerns? Is filler better for my undereye region instead? My undereye's are hallow and my nose is large (and had a 1 year lasting result of liquid nosejob to straighten it). Would there be complications from nose filler? What would be the NYC cost of eye procedures you recommend, what results do you expect?

Doctor Answers 9

Lower and upper eyelids

Without an exam in person it is difficult to say for sure.  Lower eyelid fillers can help with tear trough issues. I would avoid permanent fillers because they can be a problem long term.

New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Balancing the eyelids with surgical artistry, and non-surgical treatments for the dark circles

Looking at your upper eyelids, there appears to be asymmetry after comparing your left and right upper eyelids. I can say that the option for upper eyelid enhancement is probably blepharoplasty. In this procedure, we try to customize it for each patient where I try to balance out as much as possible the amount and volume of skin in one side versus the other. When you’re young, there is less amount of elasticity compared to when you are older so you have to choose a surgeon whom you really feel has the artistic skills to do that.

There are options in improving pigmentation on your lower eyelids. In my practice, I commonly use something called platelet-rich plasma and very often I actually combine that with hyaluronic acid. Platelet-rich plasma is derived from your own blood, and if you’ve ever heard something called a Vampire Facelift, it’s something like that where we draw your own blood and we concentrate the platelets that are the active growth factors used for healing. We place this under the skin of the eyelids to improve the quality and texture of the skin. The darkness and the wrinkling of the under eye area of the dark circles will improve, though it does not remove ethnic pigmentation.

Hyaluronic acid used in the form of Restylane can help fill a hollow, and when done very well, it can look imperceptible. Unfortunately, a lot of doctors who do this injection make the area too lumpy because the skin here is very thin. We often have patients who had fillers injected elsewhere and come to us to have it dissolved.

Being trained in facial cosmetic surgery, I can tell you that most doctors who perform rhinoplasty or nose surgery are not big fans of nose fillers, the typical ones being Radiesse ad-calcium hydroxyapatite. There have been issues with problems of skin quality after the placement of these fillers. Sometimes I’ve used it in the deepest part of the nose and forehead where the skin is thicker. It’s a little bit more forgiving when we place a filler down at the root of the nose. It’s worth considering, but I would be very careful. And since you didn’t send pictures of your nose, I can’t really comment on that any further.

My recommendation is upper eyelid blepharoplasty enhancement of the lower eyelids with hyaluronic acid and platelet-rich plasma. And of course depending where the filler is placed for the nose, you just have to be cautious about the safety and the predictability. I hope that was helpful, and thank you for your question.

Amiya Prasad, MD
New York Oculoplastic Surgeon
4.3 out of 5 stars 72 reviews

Lower blepharoplasty vs fillers

Many asian indian patients have hollowing in the under eye area and this is best treated with a hyaluronic acid filler such as Restylane. Part of the "dark circles" is due to shadowing from having a prominent brow. The filler will not get rid of the darkness, but improving the transition from the lower eyelid to the cheek should help concealer work better and draw less attention to the under eye area.  Based on your photos, it looks like a conservative upper blepharoplasty would improve the appearance of the upper eyelids. Lower eyelid filler injections can have a significant amount of bruising, so having the surgery and filler injections at the same time makes a lot of sense.

I am not sure of costs in the NYC area, but I am in Boston and suspect the costs are similar. 


Best of luck with your treatment. 

Mitesh Kapadia, MD, PhD
Boston Oculoplastic Surgeon
5.0 out of 5 stars 167 reviews

Upper and lower blepharoplasty

 the upper lids show some mild  asymmetrical hooding which can be addressed  with a conservative upper blepharoplasty.  Not much fat needs to be removed if any, from the upper lids.  The lower lids  show only a very minimal amount of excess fat herniation, so is probably not worthwhile pursuing a lower blepharoplasty. Dark circles are best treated with concealer and makeup.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 145 reviews

Upper blepharoplasty, lower lid fillers

You have upper eyelid asymmetry with excess skin. A "skin only" blepharoplasty would give you a nice result in the upper eyelids.

For your lower eyelids, the least invasive option that would give you a nice result is hyaluronic acid fillers [Restylane, Juvederm or Boletero]. That will improve the hollowness below the bulge and improve the lower eyelid contour. The dark circles, unfortunately will only minimally be improved. That is a result of skin pigmentation which is common in Indian/Middle Eastern patients. Concealers are your best bet there.

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 41 reviews

Blepharoplasty vs. Filler

You have lower eyelid fat bulge and hollowness underneath it.  You have upper eyelid skin laxity (party due to loss of elasticity and partly due to loss of fat from the brow, causing deflation effect, just like a balloon gets deflated). Fillers can help your upper eyelids and lower eyelids. The other option is blepharoplasty. Each has its pros and cons and depends on your goals. See an oculoplastic surgeon.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 74 reviews

Eyelid surgery vs fillers

From your limited pictures, you don't look like you need a lower eyelid surgery.  You appear to have hollowness and not excess fat, which is better treated with a temporary filler such as Restylane or Belotero.  Your pictures of the upper eyelids are not the most clear, but you may have some excess skin on your upper eyelids that can be removed with an upper blepharoplasty to improve the shape of your upper eyelid crease.  An in person evaluation is necessary to know if this is a good option for you.  

Jessica Kulak, MD
Fairfax Facial Plastic Surgeon
4.6 out of 5 stars 27 reviews

Lower lid issues

At your age, I would recommend Restylane for starters. Liquid rhinoplasty doesn't produce lasting results. If you have sinus or other issues, then this can contribute to the puffiness in the lower lids so I would encourage you to see a board certified ENT or plastic surgeon about this. I agree compactly with Dr Wallach on the risks of permanent filler.

Robert L. Kraft, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 42 reviews

Based on your photos, you may consider an injectable filler procedure to improve the hollowing of your lower eyelids.

Your photos are underexposed and limited for evaluation: especially your upper eyelids.

You appear to have common lower eyelid grooves that my improve after a well-performed injectable filler procedure. My personal preference for filling this area is with Silikon-1000, an off-label filler for permanent results.

Hope this is helpful for you.

Dr. Joseph

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 421 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.