Age 62 with Under Eye Circles: Lower Blepharoplasty or Fillers? (photo)

Question

I am a 62yo female who has recently consulted with several cosmetic surgeons regarding my under-eye circles. Two doctors recommended a lower blepharoplasty, but two said a lower bleph wasn't necessary and that under-eye fillers (Restylane) would yield better results. I'm genuinely confused about which recommendation to follow.

James R. Gordon, MD, FACS, FAAO · Answer

Thank you for sharing your question and posting your photograph. Your bags have progressed beyond the point where injection of fillers would help. You require lower blepharoplasty at this point. Please see a board-certified Oculoplastic Surgeon for comprehensive evaluation end guidance. Good luck!

Sam Speron, MD, FACS · Answer

Thank you for your questions and pictures!  Horizontal eyelid wrinkles and sogginess can be corrected with blepharoplasty or cosmetic eyelid surgery.  Based on the photos that you have provided, a lower blepharoplasty would benefit you over a filler option.  A full examination would be required to provide definitive treatment options.   It is one of the first cosmetic surgeries people usually get. While the average age might be 30 to 50's, some patients get this done in their 20s. It really depends on your unique anatomy as well as what exactly is bothering you.

I would recommend that you see a board-certified plastic surgeon in your area that is a member of both ASPS & ASAPS and performs a lot of eyelid lifts but also offers all the nonsurgical options such as injectables and laser treatments. Go over your concerns with them and make sure above all, you walk out of there with several options and an idea of the pros and cons to each of them as well as realistic expectations.

I hope this helps answer your question. If it does, please take a moment to up vote this answer on the “respond” button on the top right.

Donald B. Yoo, MD, FACS · Answer

Common reasons for lower blepharoplasty include tear trough deformity or pseudoherniation of the orbital fat. An in-person exam would provide a more accurate diagnosis, but preliminarily based on your photos it does appear you have pseudoherniation of fat creating "eye bags.” They should also be more prominent when you look up. Transconjunctival lower blepharoplasty with fat repositioning will provide nice results and a better lid-cheek transition in this case. @drdonyoo

Michael I. Echavez, MD · Answer

A lower blepharoplasty or fillers could both improve bags under the eyes in some people.  The dark circles you see are caused by a shadow that is created by the puffiness above.  The puffiness is caused from fat in your lower eyelids.  A filler can be placed into the area below the bags to help camouflage the issue.  This would normally be a temporary result, since most fillers that would be used in that area are not permanent.  A lower blepharoplasty would directly address the excess fat and would provide a longer lasting improvement.  It is also possible that you could try a filler first and then have surgery later, if you wished.

William Portuese, MD · Answer

From the one limited photograph, you have significant herniated fat pads in the lower lids creating the puffy look. In our practice, we do not recommend fillers placed in that area for a variety of reasons. The Fat can be removed through a trans conjunctival approach lower blepharoplasty with all the incisions placed on the inside of the lower lid.  If there's excess skin  present, then a pinch technique is performed to remove the extra skin and that incision is closed with tissue glue. No sutures are necessary. This procedure is performed under a brief general anesthetic an outpatient surgical procedure

Robert Singer, MD · Answer

Fillers often can produce a nice temporary cosmetic improvement in some patients, but not all. They certainly do not achieve what a well performed blepharoplasty will do.

Fillers can help improve the cosmetic appearance but you will get only a temporary and limited improvement with them. A better and long standing correction would be achieved with a blepharoplasty of the lower lids: Conservatively removing any excess loose skin that may be present, contouring the bulging fat pads, which are generally inherited, unrelated to weight, and tend to protrude more with time, and smoothing the tear troughs with micro-fat grafts or fat repositioning.
Keep in mind that following advice from a surgeon on this or any other website who proposes to tell you what to do based on two dimensional photos without examining you, physically feeling your tissue, assessing your desired outcome, taking a full medical history and discussing the pros and cons of each operative procedure would not be in your best surgery. I would suggest that you find a surgeon certified by the American Board of American Plastic Surgery and one who is ideally a member of The American Society for Aesthetic Plastic Surgery (ASAPS) that you trust and are comfortable with. You should discuss your concerns with that surgeon in person.

Robert Singer, M.D., FACS

La Jolla,California

Robert T. Buchanan, MD (retired) · Answer

Blepharoplasty is for when you have excess skin. You do not have any excess. Therefore, you do not need a surgical procedure like Blepharoplasty. What would work well is filler done by an expert. It appears that at least one of the physicians who suggested filler is NOT an expert as Restylane is  not the tiller you should have. Unfortunately the majority of injectors who treat this area are not experts. You need a heavy filler like Juvederm Voluma placed deep on their bone or. muscle below the orbital ligament. Look for experience and results.

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