How come Board Certified Plastic Surgeons have very different answers to plastic surgery solutions? (Photo)

Dear Doctors I have a very big issue about the whole "under the eye" treatment & solutions that doctors constantly suggest. It seems to be the MOST area in plastic surgery where doctors constantly CONTRADICT each other..It is very tiring to never hear consistency in solving under the eye problems. I thought being BOARD CERTIFIED means that you guys have similar standards since you are in a BOARD? What can u do when they all contradict each other yet they are all certified Thanks

Doctor Answers 5

Eye solutions

Bottom line, there are lots of treatment options out there. Determining the right one for any patient is going to require an in person exam. Trying to diagnose a patient from a picture is always difficult. I would suggest that use a resource such as Real Self to gather your information/research. But then schedule a consultation with a board certified plastic surgeon in your area to be assessed in person. 
My best,
Dr. Sheila Nazarian
@drsheilanazarian on Instagram

Beverly Hills Plastic Surgeon
5.0 out of 5 stars 44 reviews

How come Board Certified Plastic Surgeons have very different answers to plastic surgery solutions?

It is not uncommon to have differing opinions regarding certain areas of the body. With respect to the lower eyelids- in my opinion- the first step is to establish the location and volume of the lower eyelid fat. If the fat is bulging the shadow of the trough may be due to the fat creating the shadow. If the fat volume is normal and not bulging then the trough area may have an inherent and intrinsic problem. If the trough shadow is caused by excess fat it will respond to a lower lid blephraoplasty, which will reduce the fat volume. In the presence of normal fat- you may need a trough filler. Could be your own fat or a hyaluronic acid. Hope this helps


Great question. The reason some physicans may seem to contradict each other is because there are many ways to address the under eye area. Some patients may complain of dark circles, others may complain about puffiness, or some saggy skin. There are a variety of ways to address the under eye area with skin care products, chemical peels, a laser treatment, fillers, Botox or even surgery. Sometimes more than one of these treatments can be recommended to address the different areas around the eye or multiple areas of concern. A physician may be board certified in plastic surgery, dermatology or ophthalmology and there is frequently more than one correct way to treat an individual's concern.  I hope this helps

Camille Cash, MD
Houston Plastic Surgeon
5.0 out of 5 stars 28 reviews


Thank you for your question, and I can understand how patients can become confused by differing opinions by surgeons who are all considered experts. Board-certification by the American Board of Plastic Surgery means that we have passed rigorous written and oral examinations by our peers, and have had a sample of our own cases reviewed by the Board in great detail. It also means that we have patient safety as our main goal. It does not mean that we will all agree about the exact way to treat each case. That's a good thing. We apply basic principles, but we each bring to the case our own training and experience. Ultimately, you should choose the surgeon that makes you feel the most comfortable. Best wishes.

Paul J. Leahy, MD
Leawood Plastic Surgeon
5.0 out of 5 stars 6 reviews

Why do plastic surgeons not agree on eye surgery approaches

Thank you for asking about your eye surgery. A thoughtful question.

  • The anatomy of the eye is extremely complex.
  • There are many different ways to treat it.
  • Each way has its advantages and disadvantages.
  • The differences vary between groups - different between men and women, different ethnic groups, geographic areas.
  • Because of this complexity, every surgeon's experience and patients are different and approaches vary.
  • If we all agreed on one approach it would mean we didn't understand the complexity of the under eyelid.
  • This was the situation in the 1970s when there was one standard approach that did not work well for many many people. It still works well - for some.
  • Board Certification does not mean we all know the one 'right' thing to do. It means we are trained to think and understand the issues and find the best solution for our patients.
  • A surgeon who has an approach should be able to explain why that seems better to her/him than the approach of another surgeon.
  • Or they may both agree that their different approaches are different routes to the same end.
  • After all, driving in and out of any major city, there are many different roads you can take to get to the same destination.
Always see a Board Certified Plastic Surgeon.
Hope you find this information helpful. Best wishes.

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.