Lower Blepharoplasty vs Fillers for lower lid/cheek bony look

I have been to 2 plastic surgeons and 1 oculoplastic surgeon for opinions. There was no consensus of opinion. I have a narrow face with almost not fat, except for the bulging orbital fat in my lower lids. The area below this fat is very bony and gives the appearance of circles. I'm concerned about the long term effects of removing some of the bulging fat. Also concerned about lid retraction if the lower lid skin is pulled too much. Could restylane be used for the lower lid/cheek bony look?

Doctor Answers 16

Lower lid blepharoplasty vs. fillers

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Lower lid blepharoplasty with fat repositioning, rather than fat excision is very effective in faces with minimal existing fat to soften the lower lid/cheek junction, alleviate the dark shadows and restore a more youthful  mid-face appearance.  Fillers can also get you this look, but are less permanent and unless very skillfully placed, can sometimes make the bags appear worse. Ask your surgeon for before and after photos of previous patients treated in both ways to find which procedure matches your face type.

Salt Lake City Oculoplastic Surgeon
5.0 out of 5 stars 6 reviews

Restylane corrects tear trough.

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Of course there is no way to be sure without examining you, but it sounds like skillfully done Restylane would help you and it is not invasive.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Lower blepharoplasty vs fillers

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This is difficult to answer without seeing photos or examining you in person.  It sounds like you may need repositioning of the fat of your lower eyelid area, not removal of the fat.  Also, you may benefit from a fat transfer to restore some lost volume to your orbital area to minimize the appearance of your orbital bone, which makes patients look older.

This is a difficult to area to treat, but it must first be diagnosed correctly.  Please consult with another board certified plastic surgeon for another opinion if you are not comfortable with your previous consultations.

Best wishes,

Dr. Bruno

William Bruno, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 411 reviews

Lower Blepharoplasty vs Fillers for lower lid/cheek bony look

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Impossible to answer in the form asked. Need photos and the 4 other in person opinions you have seen! My guess is MAYBE RESTYLANE can help. From MIAMI Dr. Darryl j. Blinski

Blepharoplasty: Pros and Cons

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The concerns you mention are legitimate, but rare with an experienced surgeon. The pros of fillers are that they restore volume without surgery, many types are absorbed, and there is minimal downtime. The cons of fillers are that there are complications (as with any procedure), they are absorbed, and in the region you mention – they can be highly visible. If you are a minimalist and want to hold off on surgery – then an injectable may be a nice conservative approach for now. Surgically you sound (pictures would certainly help) like an excellent candidate for lower lid blepharoplasty with fat repositioning to the midface as this procedure would help to remove a skeletonized appearance of the eyes that occurs with age.

Be healthy and be well,
James M. Ridgway, MD, FACS

James M. Ridgway, MD, FACS
Bellevue Facial Plastic Surgeon
5.0 out of 5 stars 98 reviews

Fillers or Lower Lid Blepharoplasty for Boney Mid Face, Lower Eyelid

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Hi i,

Restylane is very good in filling the hollow under your eyelids.  You may use other fillers further away from your thin eyelid skin to give more volume to your mid-face. If you already extremely "boney" it is best to not remove any more fat.  Most importantly, choose your injecting physician most carefully.  Good luck and be well.

Dr. P

Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 39 reviews

Many ways to improve your lower eye appearance

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Up until recently, there was one way to improve the appearance of the lower eyelids- surgery. With the intoduction and expansion of "off-the-shelf" fillers, there is another tool available. Ultimately, each patient is different, but in most cases, a very nice result can be obtained with either technique.

Lawrence Iteld, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 48 reviews

Orbital Rim Implants May Be An Option for Lower Blepharoplasty Instead of Fat Removal

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With flat cheek bones and bulging lower eyelid fat, you should not remove the fat during a lower blepharoplasty. This will only make your lower eyelids look skeletonized or too hollowed out in the long term. One option to consider is to place orbital rim implants which will build out the deficient lower eyelid rim. This will get rid of the bulging lower eyelid fat appearance.

Lower eyelid circles

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There are two ways to correct the lower lid circles, blepharoplasty and fillers, including fat and off the shelf fillers. Modern blepharoplasty does not remove any of the fat from the lid, but, instead, repositions it. It also supports the lid so that you should not get lid retraction. This is a permanent solution to your problem. Of the fillers, fat is the only really permanent one that I would use. Other fillers are less expensive initially, but have to be repeated. Make sure whomever you use has significant experience.

Robert T. Buchanan, MD
Highlands Plastic Surgeon

Lower Blepharoplasty vs. Fillers

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Don't be surprised by the lack of consensus, especially for the issue that concerns you.  There are many ways of addressing this.  In general, the things that affect the lower eyelids with age are excess fat, excess skin, or both.  Excess skin can be removed.  If it is done conservatively (which an experienced surgeon will do), you have very little risk of lid retraction.  If you have excess fat, you have a few options.  First, if it is minimal and you are concerned about having surgery, the "tear trough" that is created by the excess fat bulge can be filled in with a filler.  Restylane is OK, but I think Juvederm is better for this. This is a very good option for someone who has more facial volume at the cheek.  If you are as thin as you say, however, then filling in the trough may just make your fat buldge look larger.  In such a case, surgically removing some of the fat is the best option.  If the fat bulge is the only issue and you do not have excess lower lid skin, then this can be done from within the eyelid so the risk of lid retraction is extremely small.

Gary D. Breslow, MD, FACS
Paramus Plastic Surgeon
5.0 out of 5 stars 44 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.