I have lines and bags under my eyes. Would you recommend surgery or filler? (photos)
Doctor Answers 8
For under eye bags that are always present surgery is best, but for lines non-surgical treatments to improve skin quality
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.
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Bags under eyelids – filler versus surgery
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.
Treatment options for lines and bags under eyes
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I have lines and bags under my eyes. Would you recommend surgery or filler?
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
I have lines and bags under my eyes. Would you recommend surgery or filler?
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.
Recommendations for lower eyes
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.
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
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