I've had 3 consultations (2 plastic and one ocular plastic surgeon) for under eye bags with three opinions. (photos)

Which do I choose? 1 surgeon said I needed a lower and upper bleph, 1 recommended 1 vial of Voluma for both eyes around the upper cheeks and some diluted with water around the eyes, ocular guy said they weren't bad but if he performed surgery he would do a lower transcon bleph and remove all 3 fat pads. Is that conservative? What is the aggressive type of the past? I asked about the arcus marginalis release and he said it wasn't predictable and you can sometimes end up lumpy. I don't want to look worse or hollow.

Doctor Answers 9

Fat repositioning

In your instance I favor a transconjunctival approach  and as you mentioned marcus marginalis release with fat repositioning.  My experience is that it has less risk for lumpiness than fat transfer or filler type injections.  

Bellevue Facial Plastic Surgeon
4.3 out of 5 stars 21 reviews

Differences in Opinions on Lower Bleph

Your experience is not uncommon. It highlights that there is no absolute way to do things, and that the "best" procedure is the procedure that works best in each surgeon's hands. To help yourself, ask for photo examples of patients that may be similar to you that have been handled by each surgeon in their practice. Personally, I like the transconjunctival approach with a possible skin pinch based on your presentation in the photos. Again, there is generally no "best"...just what works well in one's hands. Best of luck.

You need upper and lower blepharoplasty

Trust the surgeon who recommended surgical treatment.  Do not go for any injections.  Oculoplastic surgeon is right in recommending against arcus release. It can be quite harmfull.

Vasdev Rai, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 21 reviews

Best method for under eye bags

You do have under eye fat prolapse. The best method that is least invasive, give natural results, and avoid hollow sunken eyes, is transconjunctival lower blpeharoplasty with partial fat removing and partial fat repositioning. See link and video below.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 58 reviews

Transconjunctival arcus marginalis lower eyelid surgery would be state of the art.

You have a lower eyelid that will be harmed by transcutaneous lower eyelid surgery because it weakens the muscle that helps hold the lower eyelid against the eye.  I think what you are telling us, is that among the surgeons you have seen, you have not found someone you are comfortable with.  In my office, we would also discuss lower eyelid fillers which look like they you be very helpful for you and are a definite alternative to lower eyelid surgery.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
4.9 out of 5 stars 23 reviews

Lower lid blepharoplasty

If you go to 10 doctors you will get 10 different opinions. But based on these photos:  Upper lid bleph would help to remove the excess skin.  For the lowers:  if you don't want surgery, use some HA filler such as Restylane to smooth out the area.  For surgery - I always prefer to reposition the fat into the tear trough as opposed to taking it out.  When done correctly it should not produce any more irregularities than fat removal can.  And then you don't have to be adding filler or fat down the line.  Take a look at patients who have had fat repositioning to see what you think.     

John J. Martin, Jr., MD
Coral Gables Oculoplastic Surgeon
5.0 out of 5 stars 24 reviews

Upper and lower eyelid surgery

A conservative augmenting upper blepharoplasty will better define the contour of your eyes. With regards to the lower eyelid I agree with the plan of a transconjuctival blepharoplasty and partial fat excision/advancement.  You may still need hyaluronic acid layering on the eyelid cheek junction to further define the post-op contours.

Costas Papageorgiou, MD, FACS
London Facial Plastic Surgeon
5.0 out of 5 stars 16 reviews

Dark Circles, Eyelid Wrinkles/Bags Treatment -- Restylane or Belotero with Cannulas, Clear+Brilliant, Eclipse Micropen, Viva

The eyes are best treated with a combination approach of fillers, lasers, microneedling/PRP for improvement. Ultherapy/thermage, venus legacy all do well for swelling or puffiness. I would suggest consulting an expert. If surgery is an option they will recommend and that can be done in combination with other non invasive options. Best, Dr. Emer

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.9 out of 5 stars 158 reviews

Multiple opinions

When there are multiple opinions I usually recommend that you go with the doctor you feel most comfortable with and who has the most experience. You need to have 100% confidence in your doctor before proceeding with surgery.
Based on your photos I would recommend transconjunctival lower blepharoplasty to remove the extra fatty tissue under your eyes.I do not think releasing the arcus marginalis adds much to the procedure but other doctors will disagree with this. I will sometimes add filler to help blend the eyelid-cheek junction 6-8 weeks after surgery to optimize the results. I find filler injections are a lot more predictable than fat grafting or repositioning.
If you were not interested in surgery, adding volume to your upper cheeks (below the bags) can help camoflage the extra fatty tissue, but the results would not be as good as surgery. If you are looking for a little improvement, filler injections alone could be an option, but removing the extra fat would give you the best results.

Mitesh Kapadia, MD, PhD
Boston Oculoplastic Surgeon
5.0 out of 5 stars 145 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.