Bellafill instead of blepharoplasty? 26 y/o (photos)

So 1 out of 4 doctors just told me I will be better with bellafill under my eyes instead of surgery since I would look older with the fat removal and what I need is volume. Too scare if something goes wrong, how would this filler will look when aging? seems like the first opinions of the other 3 doctors was similar trying to say I need restylane or juvaderm but I want to go with something permanent then they recommend me the blepharoplasty. I tried fillers before. What's my best shot here?

Doctor Answers 6

Bellafill for Under the Eyes or Tear Toughs

Bellafill, in the right hands, is an excellent treatment for your problem.  If a cannula is used, Bellafill can almost be airbrushed into place to give a great result in a patient like you who does not have excess skin and simply has volume loss in the malar or lower eyelid area.  I have added a web link to before and after photos of many patients just like you who I have treated with Bellafill.

I hope that helps.

Best regards.


Kirkland Plastic Surgeon
4.9 out of 5 stars 56 reviews

Classic Anatomic Changes That Are Treated Most Successfully With Lower Eyelid Blepharoplasty and Facial fat Grafting

I commend you on doing your own research and making the effort to get multiple opinions so that you will get the best result that you desire. Naturally, you want to achieve the most effective and long lasting results available. It is evident that injectable soft tissue fillers have left you less than satisfied and, I believe, as I suspect you may believe as well, will continue to do so, including Bellafill. I use quite a lot of Bellafill and I am a trainer to physicians with this product. I do not train physicians to inject Bellafill around the eye area; it seems to lead to the most frequent calls to the company over problems and dissatisfaction. I believe the reason why you have experienced suboptimal results with injectables in the past is because of the predictable anatomic changes (you are by no means alone, as it is not a matter of if but when in all of us will experience these changes) that have already occurred in your under eye area, at present time. This process has had no regard for your specific age and surgical correction, just like the injection of soft tissue fillers, is based upon the presence of anatomic changes, and not a woman's age.

From your photos, one can clearly discern these changes: volumetric changes that include fat herniation (puffy eyes), visibility of the C-shaped anatomic structure along the junction between the lowest area of visible fat and your cheek bone, and volume deficiency of your cheek bone. Ultimately, these changes have left you with a tired look: "bags and dark circles", along with what appears to be a long vertical distance when measuring from your lower eyelid margin to your apparent cheek bone.   The goal of any treatment, surgical and/or non-surgical, is to recreate an apparent short vertical distance from the lower eyelid margin to the cheekbone. Based solely on your photos, and if you were a patient of mine, I would be very surprised if you did not say to me" Dr. Bazell, I am tired of being told I look tired even when I am not tired. I can get 12 hours of sleep and people will still think I'm tired. Friends will say 'Are you alright? Are you getting enough sleep? Is everything OK?'".  Additionally, I would also be surprised if a good portion of your time in the morning and beyond was not occupied with the reducing your puffiness, which you may notice changes with salt intake, lack of sleep, allergies, emotional state (crying while watching a great but sad movie),etc., and that you have tried products and home remedies, such as cold compresses, bags of tea, cucumbers, clay masks, preparation H (a lot of my patients say that they have tried this), in an effort to reduce the puffiness.

I believe that to get the best cosmetic outcome, achieve a quality of lifestyle change, and obtain a natural and youthful result (which is probably what you are hoping for, yes?) it will require both the removal of your  puffiness and the replacement of your cheek bone volume loss. Based upon your photos, I believe soft tissue fillers in a syringe will never do this for you.

Because  I do not see any excess skin in your lower eyelid region (and your skin quality appears, visually, to be quite good), a lower eyelid blepharoplasty through a hidden, internal (transconjunctival) incision, such that there is no visible scar on your face, will effectively remove the puffiness from your face (and your life!) and, with the addition of facial fat grafting, the lost volume in your cheek bone area will be replaced safely, effectively and with the most long term results, better, in my experience, than with any other injectable available on the market to day.

I hope this helps you in your decision and if you have any questions, please do not hesitate to contact me.

Bellafill versus blepharoplasty

I would not recommend using Bellafill under the eyes, as irregularities can be visible there because of the thin skin.  My recommendation for fillers under the eyes would be one of the hyaluronic acid fillers, such as Restylane.  

Michael I. Echavez, MD
San Francisco Facial Plastic Surgeon
4.5 out of 5 stars 18 reviews

Eyelid Wrinkles/Bags -- Restylane or Belotero, Clear+Brilliant/Fraxel, Eclipse Micropen/PRP, Viva/Intensif, Botox/Dysport/Xeomin

I would not inject bellafill to the lower eyes. I suggest reversible fillers to this area, lasers, and microneedling/PRP.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.9 out of 5 stars 165 reviews

Non Surgical Blepharoplasty

Hi and thanks for your question. You are quite young, so it would be nice if we could avoid surgery as long as possible. From your photos it looks like you have some early volume loss in the area of your cheek and under eyes. I would suggest avoiding Bellafill. It is a permanent filler, but it is not reversible and the under eyes are a bit unpredictable as to swelling. I perform filler injections under the eyes and in the cheek area on a daily basis. I take Juvederm and prepare it specifically for injection into the under eye area. This preparation is soft and natural looking and gives patients 2 to 6 years of duration. Most importantly, it is easily dissolved with enzyme. In my office, this is a two stage procedure, with a touch up visit 2 to 3 weeks after the initial one. Feel free to take a look at the before and after pictures on the website. Hope that helps.

At 26, do not have blepharoplasty, Bellafill is a good option

You need the fat around your eye. If removed, you will look skeletonized in the future. If you go to an experienced doctor, Bellafill is a great option for this area. Do it slow, maybe one syringe per side and see how it goes. Add more later. Another option is Restylane. Make sure the doctor uses cannulas for this injection for safety and less bruising.

Steven F. Weiner, MD
Panama City Facial Plastic Surgeon
4.6 out of 5 stars 26 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.