I'm 27 years old and suffer from under-eye puffiness. Candidate For Transconjunctival Blepharoplasty or Restylane Filler?(photo)

I am 27 years old and suffer from under-eye puffiness. I'm in dire need to correct this situation in order to restore my youth and happiness and not hide behind my glasses as I've been doing for years. Am I candidate for the less evasive Restylane filler? Or would you recommend full Transconjunctival Blepharoplasty?

Doctor Answers 34

You are an ideal candidate for transconjunctival lower blepharoplasty

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I am a huge fan of fillers for the improvement of lower eyelid bags- especially in young people.  The vast majority of the time, lower eyelid bags are caused by age-related volume loss that show up first along the lower orbital rim.  This accentuates the "valley" between the cheek and the lower eyelid, making the lower eyelid bags painfully obvious.  Fillers can expand this "valley" and restore a smooth contour to the lower eyelid-cheek continuum.

Your photo is quite helpful, and you are an example of the minority of patients- you were born with fullness of the lower orbital fat, and a tight orbital rim ligament.  Translation: you are an ideal candidate for transconjunctival blepharoplasty.  A lower bleph in your case is an elegant, simple, lifelong solution for your problem.

Bottom line: fillers are for rejuvenation and surgery is for transformation.  You were born with a little too much lower orbital fat and surgery is the way to go.

Good luck! 

Austin Oculoplastic Surgeon

Lower eyelid surgery to remove fat bags

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 You photos show the classic signs of lower eyelid fat bags in the central and medial fat compartments.  Lower eyelid surgery through a transconjunctival approach would take about 30 minutes and would resolve the issue.  Do not waste your money on soft tissue fillers that will make the area appear larger and more full.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Treatment of eyelid bags

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you look like you would be a good candidate for a TCLB- transconjunctival lower blepharoplasty.

Filler works too, but in order to conceal the puffiness, you need to fill up to such a level that the eyes appear puffy.

Your problem often runs in the family and has nothing to do with aging of the eyes.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 194 reviews

Transconjunctival blepharoplasty for eyelid bags.

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Transconjunctival blepharoplasty for eyelid bags will be the treatment you need since the bags are quite large. Fillers will make things worse.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 38 reviews

Lower lid puffiness

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Thee is no question about it, you need the excess fat removed from your lower lids.  Having this done by the transconjuntival approach is good in a younger ores on and one with darker skin to eliminate scarring.  Don't even consider injectable fillers for your situation.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 29 reviews

Blepharoplasty vs Restylane

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I do not think you will benefit from Restylane.  You photo indicates that you probably have pseudoherniation of the fat pads of your lower eyelids.  The best treatment of this would be a transconjunctival lower lid blepharoplasty.  I occasionally see this in younger patients such as you; I think this most commonly represents a familial tendency when seen in the young.

John Whitt, MD (retired)
Louisville Plastic Surgeon

Transconjunctival Blepharoplasty

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Hi Megan,

You are definitely a candidate for a transconjunctival blepharoplasty. The bulging that you see is orbital fat herniating out causing the puffiness. A transconj blepharoplasty is quick and safe to do and will correct the puffiness under your eyes. This procedure can be done under local anesthesia and recovery is about 4 to 5 days. You can check my website below which is dedicated to ethnic facial cosmetic surgery.



Oleh Slupchynskyj, MD, FACS
New York Facial Plastic Surgeon
4.8 out of 5 stars 285 reviews

Candidate For Transconjunctival Blepharoplasty or Restylane Filler?

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Thanks for the posted photo. It really helps advise. I recommend transconj. lower bleph. as the first option to remove the medial/central fat pockets. This would be under local + sedation. Healing in most cases 1 week. From MIAMI 

Transconjuctival blepharoplasty vs restylane filler.

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I would recommend transconjuctival blepharoplasty with fat transposition over the infereior orbital rim.

Mario J. Imola, MD, DDS, FRCSC, FACS.

Mario J. Imola, MD, DDS
Denver Facial Plastic Surgeon
4.9 out of 5 stars 124 reviews

Treating eyelid puffiness

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You are indeed one of the few patients that would truly benefit from the transconjunctival approach.  I would however recommend fillers before or at the same time as the blepharoplasty to avoid bringing attention to flatness of your midface.  I would also recommend a fat transposition approach to the transconjunctival blepharoplasty instead of removing fat.  I hope this helps!


All the best,


Rian A. Maercks M.D.

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.