I have lines and bags under my eyes. Would you recommend surgery or filler? (photos)

I have lines and bags under my eyes and I'm not sure how to handle them. I've tried peels, creams, serums...I'm not just getting great results under the eye anymore.

Doctor Answers 8

For under eye bags that are always present surgery is best, but for lines non-surgical treatments to improve skin quality

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
As an oculofacial cosmetic surgeon, I do a lot of eyelid procedures. For lower eyelid rejuvenation, there are some key elements that should be addressed to maximize results. I first assess for lower eyelid fat prolapse where the eyes are puffy all the time regardless of adequate sleep or management of allergies or sinuses. It is caused by herniated fat which has pushed forward. In order to address that, we do a lower eyelid blepharoplasty.

Depending on the presence of redundant skin or laxity of the lateral canthal tendon which supports the lower eyelid, we make decisions on whether to do an external approach called a transcutaneous blepharoplasty or an internal approach called a transconjunctival blepharoplasty. Most of my patients who come for eyelid surgery typically don’t have excess skin so I generally do a transconjunctival blepharoplasty. If they do have some extra skin, I do a transconjunctival blepharoplasty with a skin pinch excision. In our practice, we do all these procedures under local anesthesia with LITE™ IV sedation.

Years ago, when I would do an isolated blepharoplasty, I was always challenged with the issue on how to manage the skin. In addition to the puffiness of the eyes which is a big negative, there might be the presence of fine lines and wrinkles that make the eyes look aged in appearance. It is important to distinguish skin quantity from skin quality. People who have wrinkles under the eyes will undergo procedures to remove what they believe is excess skin. Unfortunately, a lot of those people will have a shortage of skin after the surgery that leads to rounded lower eyelids. In other words, their eyelids get pulled down called lower eyelid retraction.

I would advise you to be cautious and understand that a distinction between skin quality versus skin quantity has to be made. When you have fine lines under the eyes, then skin quality is the dominant issue. In skin quality, we are dealing with loss of collagen, blood supply and the thickness of the skin. Our current approach to addressing skin quality is usually a combination of application under the skin using platelet-rich plasma. Platelet-rich plasma is derived from your own blood and it concentrates the growth factors necessary for healing. We stimulate collagen, blood supply and improve skin quality. In addition, we’ll use fractional CO2 laser which addresses the superficial lines and improves the skin quality through collagen stimulation.

I suggest that you meet with qualified experienced cosmetic surgeons particularly those who have a lot of experience with eyelid surgery and understand that there are some potential pitfalls. Also consider the integrity of the support structures of the lower eyelid that need to be addressed, but is often overlooked by a lot of general plastic surgeons. That being said, get a sense of what your options are and hopefully this information will help guide you. I hope that was helpful, I wish you the best of luck, and thank you for question.

This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.

New York Oculoplastic Surgeon
4.4 out of 5 stars 80 reviews

Bags under eyelids – filler versus surgery

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Our eyelids are one of the first areas of our body to show signs of aging. The skin changes by getting a crepey quality with find wrinkles and loss of elasticity. The fat pads that sit around our eyeball also begin to bulge forward creating those lower lid bags. Underneath that bag is a groove, called the palpebromalar groove, which becomes further accentuated as the cheek fat pad sitting below it heads south.
The skin changes can be targeted with robust chemical pees, and/or laser treatments. Both of these give very beautiful results on the lower eyelid skin which is very thin. A neuromodulator, like Botox, can also help if any of that bulkiness or wrinkling is due to the muscle that surrounds the eye.
To target the eye bag or the groove that forms underneath it, filler can be used to physically fill it in. This is just a temporizing measure and does not actually address the underlying problem, but if it is done repeatedly over time it can maintain a youthful looking lower lip and cheek junction.
A lower blepharoplasty surgically addresses these lower eyelid aging changes by physically putting the fat pad back where it supposed to be, and/or draping that fat pad to fill the groove sitting below the bag. I ppreferto do this through a transconjunctival approach which l leaves no scarring on the lower eyelid.
In helping you to make this decision, be sure you choose a dermatologic surgeon, oculoplastic surgeon, facial plastic surgery or plastic surgeon who is board certified in one of the core four cosmetic specialties.

Cameron Chesnut, MD, FAAD, FACMS
Spokane Dermatologic Surgeon
4.9 out of 5 stars 121 reviews

Treatment options for lines and bags under eyes

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
It is important to understand what each treatment option can achieve. Fillers can fill hollows (like pot holes in the road) and lift tissue to add fullness. However, they do not change fine lines in the skin. Surgery will remove excess tissue, and it too will not treat fine lines. In fact chasing lines with surgery will invariably lead to changes in eyelid shape and complicated revisions. What I would recommend, is consulting with an expert eyelid surgeon so he can personally evaluate your options with you to choose the best procedure for your needs. Good luck with your search.

Dr. Massry

Guy Massry, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 54 reviews

I have lines and bags under my eyes. Would you recommend surgery or filler?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Most expert experienced artistic plastic surgeons have a variety of procedures at their disposal to produce excellent cosmetic results in the appropriately selected patient: neurotoxins like Botox or Dysport, temporary fillers, micro-fat grafts, blepharoplasties , and combinations of those options. There is no one best procedure. Each has benefits and drawbacks.

Following the advice of anyone who would presume to tell you what to do without taking a
full medical history, examining you, feeling and assessing your tissue tone, discussing your desired outcome and fully informing you about the pros and cons of each option would not be in your best interest. Find a plastic surgeon that you are comfortable with and one that you trust and listen to his or her advice. The surgeon should be certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS). You should discuss your concerns with that surgeon in person.

Robert Singer, MD FACS

La Jolla, California

Robert Singer, MD
La Jolla Plastic Surgeon
4.6 out of 5 stars 22 reviews

I have lines and bags under my eyes. Would you recommend surgery or filler?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Although more accurate recommendations can be determined after an in-person physical examination and review of your medical history some initial comments can be presented from your photos.

When evaluating the lower eyelid area it appears you have moderate wrinkles (crow's feet), excess skin which may be exacerbating the wrinkles to some degree, and perhaps some amount of eyelid "bags" underneath the excess lower eyelid skin.

Treatments for the wrinkles and excess skin can be laser or better yet a lower pinch technique.  But, if eyelid "bags" are present the "bag" would have to be addressed as well, because if the excess skin is removed and the "bag" is not corrected, the "bag" may become more apparent.  This is similar to the analogy of a pillow hidden underneath a messy, bunched up bedspread.  Once the bedspread is tuck in the underlying pillow (aka. "bag") becomes noticeable.

I hope this helps and more explanation can be found on the link below.  

Timothy R. Miller, MD
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 74 reviews

Recommendations for lower eyes

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Hello and thank you for your question.
One is not able to appreciate your eye bags from those pictures. Assuming you do indeed have them, you would be best suited by having a blepharoplasty plus or minus laser resurfacing of the lower eyelids to treat both the eye bags and the excess wrinkled skin. I recommend that you see a board certified plastic surgeon in consultation to get more specific answers to your questions which can best be addressed after a thorough history and examination is performed.
Best of Luck to you!

Multiple lines, folds or wrinkles of the lower eyelids cannot be fixed with surgery or fillers.

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

The lines that you see beneath your eyelids in the in the crows feet area are due to overactivity of the eyelid muscle and possibly sun damage or aging changes in the skin.

Surgery or dermal fillers will not correct this problem.

Botox will reduce the appearance of these lines out in the crows feet area and on the outside portion of the lower lid.

However ablative laser resurfacing is the best option to reduce the severity of the eyelid wrinkles and should be combined with Botox treatments.

Please consult a board certified plastic surgeon who is an expert at oculoplastic and laser surgery.

Filler or Surgery for Lower Eyelids

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Even with the pictures, you require a direct examination to determine what you need to improve your lower eyelids. Fillers can erase both lines and wrinkles around the eyes by elevating the tissues and filling the area under the wrinkles, thus stretching them out. This works especially well for lower lateral crow's feet. If, however, the wrinkles are too severe, the only answer is surgical removal of the excess. Make sure you see a plastic surgeon with significant experience in both surgery and fillers.

Robert T. Buchanan, MD
Highlands Plastic Surgeon

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.