Candidate For Transconjunctival Blepharoplasty or Restylane Filler? Or I'm to young for this ?

I am 24 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? or im to young for this ? List Pros & Cons, Advice you can offer others.

Doctor Answers 19

Am I a candidate for Transconjunctival Blepharoplasty?

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From the photos you do appear to have lower eyelid fat bags.  These would be reduced wioth a transconjunctival may want to have a few consultations to explore your options.

Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Too Young for Under Eye Bags

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All other things being normal on your exam, I would opt for the transconjunctival blepharoplasty. 

I am usually not so adamant with my answers but from your story and photos it does seem like your under eye bags are more of a hereditary problem rather then aging.  If your cheekbones are flat I would consider fat grafting as well. Personally, I do not like the results from filler in this particular situation.  Further, you will be potentially be getting injections every 6-12 months for years!

Having a frank discussion with a provider you trust who can examine you is critical. How have they obtained their best results in similar situations in the past?  What treatments work with your lifestyle and price range? These are all important questions.

Good luck!

Hannah Vargas, MD
Kansas City Facial Plastic Surgeon
4.8 out of 5 stars 48 reviews

Oposite treatment

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Your problem is very complex, transconjuctival blepharoplasty will remove volume, filler injection will add volume!!! as you can see, this does not make too much sense.

Neither one of these options is the best, you can get partial solutions with either. This is usually a familiar trait, most of the time patients like you also have loose skin in the lower eyelid, this can only be determined with an examination. There are 3 key components on examining your problem, excess fat (bulging bags), tear trough deformity (the groove under the fat bags) which is a volume deficiency and most likely excess skin. There are many ways to approach these problems, you need to see a surgeon with experience on blepharoplasties, there are 3 major specialties in which you can find good and bad surgeons (PLastic surgeons ABPS certified, Facial plastic surgeons, which are ENT doctors and Oculoplastic Surgeons, which are ophthalmologist)  You need to see pictures from the surgeon, the best way to find out if they have experience with patients like you is if they can show you pictures of young patients like you, also is very important for you to check the lateral photographs, with this view you can check if the problem is corrected with their proposed treatment. Good luck in finding a good surgeon


Victor M. Perez, MD, FACS
Kansas City Plastic Surgeon
5.0 out of 5 stars 30 reviews

Restylane or Eyelid surgery

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Before I decided, I would see an eyelid specialist (oculoplastic surgeon) and a dermatologist or plastic surgeon. The reason is that an oculoplastic surgeon can tell you whether removing the fat pad will provide you with the result you are looking for and also consider some other factors before treating you. A good plastic surgeon can do the same thing. However, a dermatologist usually does not perform this surgery so wont be able to give you the pros and cons for that aspect of your question.

My impression, based on what I see, is that you may need to get the fat pad removed. However, I would see someone that does this type of surgery before deciding.

Kenneth Beer, MD
Palm Beach Dermatologic Surgeon

T-c v. restylane

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yes and yes. the bleph is ideal for lowering the fatty bulges. restylane would be useful for your nasojugal creases. so you may benefit from both. start with the bleph though because it is an immediate long term result. good luck.

Rafael C. Cabrera, MD
Boca Raton Plastic Surgeon

Take your time making decisions where advice is sketchy.

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Age 24 and already hiding behing glasses............sounds like you have a congenital or familial problem and in these cases correction doesn't have to wait any longer than reaching adulthood(say age 19). I'm not sure from the photos (thanks for them by the way as we really need to see photos to be able to answer properly) but it looks like you need fat reduction from the lower eyelids for sure. Padding the lower groove below the fat protrusion with a filler (Restylane or anything else) will not correct the problem! The bulge will still be there. Surgery is needed! However the nature of the surgery ,I think,  is different from the transconjunctival surgery you ask about. Personally I think a blepharoplasty that reduces the fat bulge is necessary AND use this fat as a drape down over the lower orbital rim to padd this area (grooved area below the fat projection) where you were thinking of having a filler injected. Sliding the excess fat down in the hollow will accomplish a reduction in the bulge AND at the same time fill the groove or hollow.

See an experienced plastic surgeon with experience in this type of blepharoplasty. It may well involve an external approach where the scar is close to the lash line and almost undetectable but the result should be excellent.

Harlow Hollis, MD
Victoria Plastic Surgeon

You may be a candidate for a well-performed Injectable Filler procedure to minimize the appearance of your lower eyelid bags.

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I read your concern and reviewed your photos:

You appear to have fairly typical lower eyelid grooves that are between your lid-bags and your cheeks. Artfully placed filler in these grooves may diminish the appearance of your lower eyelid bags. You must be certain that your doctor is familiar with the delicate art of injecting lower eyelid skin, as this area may be unforgiving. I prefer using Silikon-1000, an off-label filler for permanent results, when filling lower eyelid grooves. In my view, you should not have your lower eyelid fat removed as this may lead to a hollow, "operated" appearance.

I hope this is helpful for you.

Regards from NJ.

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 435 reviews

Under Eye fillers or Surgery

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It's a little hard to tell from your pictures what would be right for you.  I would say there is absoloutely no harm in trying some volume filling under the eyes at this oint.  Just be sure to find someone with a lot of experience doing this.  If this is unsatisfactory, you can always opt for a surgical correction at a later date.  A personal consulation with a cosmetic physician would be best to help with your decision.

Louis M. DeJoseph, MD
Atlanta Facial Plastic Surgeon
4.9 out of 5 stars 32 reviews

Subconjuctival Blepharoplasty for lower eyelid bulges

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Age 21 is a bit young to be considering lower lid surgery, however, judging from your photos, you do have signifigantly protruding fat pads.  The fat pad bulges are not related to body weight, but are usually a familial trait which becomes more pronounced over time.  A subconjunctival blepharoplasty would result in removal of the fat pads without skin incision or scarring.  The fat pads generally do not regrow, so results are relatively permanent.  In evaluating your pictures,it is not clear exactly how to treat, as photos to assess this area are best taken when looking up, and also looking directly forward.  Your best bet is to have in-person consultation(s) with one or more board certified plastic surgeons who specialize in cosmetic plastic surgery (members of the American Society for Aesthetic Plastic Surgery).

Pamela B. Rosen, MD
Coral Springs Plastic Surgeon

Transconjunctival Blepharoplasty

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Regardless of age, some patients suffer from congenital or familial lower lid fat herniation. From the pictures below you are good candidate for transconjunctival Blepharoplasty. I don't think that fillers will give you the results that you are looking for.



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