Age 27- Restylane or Juvederm in Tear Troughs or Blepharoplasty? (photos)

In the last two years, it seems as if my eyes have aged significantly. I have always had some form of eye puffiness, which has gone down significantly through controlling allergies with antihistamines (Claritin).However, now that the puffiness is less of an issue, I still have "tired" looking eyes. In my profession, I am in front of the camera a lot and this is affecting my confidence at work. Am I a better candidate for eyelid surgery, or should I try fillers first in the tear trough area?

Doctor Answers 6

Lower Lid Bags Treatment

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I would start with Restylane under the eyes.  That is the only filler I will put under the eyes.  (Other fillers  tend to take on water and can cause swelling under the eyes which takes forever to go away). If it is not enough to make you and the camera happy then do a fat bag removal or repositioning through the inside of the eyelid (transconjunctival).  There is no reason to cut your skin and give an added scar from what I can see in your pictures. 

Florham Park Oculoplastic Surgeon
4.6 out of 5 stars 21 reviews

Puffiness under eyes

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Your pictures show a significant herniation of fat in the lower lids. Fillers will not help with  that amount of herniated fat.  This is treated best with a transconjunctival lower blepharoplasty.  No skin removal recommended.  Expect to take 2 weeks away from the camera work to recuperate.  It is also helpful to make sure your allergies are well controlled with nasal sprays or antihistamines 

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Transconjunctival blepharoplasty with fat repositioning

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Transconjunctival blepharoplasty with fat repostioning [rather than complete removal] would be my recommendation to you. I would be very hesitant to remove any skin on you at this time. You have prominent eyes and relatively flat cheeks [malar region] and this would predispose you to developing lower eyelid retraction [eyelids pulled downwards].

At some point, you may consider fat grafting to the cheek region to contour the eyelid/cheek junction more naturally.

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 42 reviews

Injectable Filler in Tear Trough for Eyelid Puffiness

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You have two options. A more permanent solutions is lower lid transconjunctival blepharoplasty to surgically remove the lower lid fat bags with external incisions or visible scars. Alternatively, Restylane or the lighter weight Juvederm can be injected into the tear trough to make the bags less noticeable. However, filler treatments will not make the bags entirely go away. Restylane should last 1 to 11/2 years. In my opinion, since you are in the public eye, your would have the most benefit from surgery.

Anita Mandal, MD
Palm Beach Facial Plastic Surgeon

Treatment for tear troughs

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I believe you could get improvement to your tear trough areas either with lower eyelid surgery or with fillers.  If you used Restylane or Juvederm (or Belotero), it could be injected under the puffy area to help smooth out the appearance.  If you had surgery, some of the fat causing the puffiness can be removed to help.  It also appears that you might benefit from removing a small amount of skin on your lower eyelids as well.  Of course, the final word would be after having you examined in person.  

Michael I. Echavez, MD
San Francisco Facial Plastic Surgeon
4.5 out of 5 stars 18 reviews

A combination of treatments for hollow, puffy, and dark under eyes

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Thank you for your question, and for the detailed pictures you sent showing your under eyes from different angles. 

I would first determine whether the puffiness of your eyes is a recurring problem or a constant one.  If your eyes are relatively modest or low most of the time, then fillers such as Restylane can be a good option.  It is important to remember that the use of fillers is often prescribed by doctors who are not surgeons and can’t perform eyelid surgery. As a specialist in surgical procedures in the eyes and face,  I often see patients that have had too much filler, which can cause their eye bags to look even bigger.  If your eyes are puffy all the time, then this is likely caused by the fat pockets behind your eyes being pushed forward and creating a bulge.  In this case, I would recommend undergoing transconjunctival blepharoplasty.  This involves going behind the eyelid and sculpting, shaping and reducing the fat pockets so they no longer bulge, and creating a natural contour.

To create a natural look may not only involve just the eye area alone.   If there is still relative hollowing and dark pigmentation in the eye to the cheek area, I would enhance that transition point , also known as the lid-cheek junction.  If this area is hollow and darkened by pigmentation, in my practice I routinely use platelet rich plasma or a platelet rich fiber matrix.  This is basically your own drawn blood with added factors responsible for healing.  This is placed under the skin to buildup collagen and stimulate new blood supply. I would additionally use volume-enhancing fillers such as Restylane to complete the enhancement of the whole eyelid-cheek area to achieve a natural look.  It is important to keep in mind that people look at the face as a whole,  and not just one particular area such as the eyes.

This combination of procedures involve a certain finesse, skill, and artistry.  People can be unhappy with the results of using injectables, but it is often the technique and style used that cause an undesirable result, not the material itself.  For your situation, I would recommend considering transconjunctival blepharoplasty, along with some skin and volume and enhancement in the tear trough and lid-cheek junction area.  It is important to be personally examined by a specialist that is an experienced eye and facial cosmetic surgeon. I hope this was helpful, and thank you again for your question.

Amiya Prasad, MD
New York Oculoplastic Surgeon
4.4 out of 5 stars 80 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.