Blepharoplasty vs. filler (Restylane) for under eye bags? (photo)

Thank you for your question. At age 21, you are aware of significant bags under your eyes, which you recognize as likely t caused by genetics. You intend to have lower eyelid blepharoplasty but you’re hoping for a quicker short-term solution. You’d like to know if you can undertake surgery after having Restylane placed. Further, you want to know the details of how long afterwards, as well as precautions.
In my practice, I perform a significant volume of both cosmetic eyelid surgery as well injectable fillers for the improvement of tear troughs as well as under eye bags. I’m Dr. Amiya Prasad. I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. I can help you understand the options which will potentially be optimal in your best interest.
Often, patients with significant under eye bags feel they can’t dedicate time for a surgical procedure such as lower eyelid blepharoplasty, therefore try to delay the surgery by undergoing injectable fillers. Although you submitted a single photo which shows the under eye bags from the front, I would typically evaluate the patient looking from several different angles to determine the degree of projection of the fat pockets under the eyes, and relative hollowness of the area of the tear trough, the eyelid-cheek junction, and the cheekbones. Once that assessment is made, I counsel my patients on whether or not fillers would have any benefit.
There are situations where a person has fairly prominent eyes and recognizes that the use of fillers will not result in a 100% correction. However, they do have appreciation for some degree of limited improvement while waiting for their schedule to allow them to undergo surgery. Very often, patients are not aware that they can actually recover fairly quickly from lower eyelid surgery.
In my practice, I perform lower eyelid surgery under local anesthesia with LITE™ intravenous sedation and employ several modalities to minimize the amount of swelling and bruising afterwards. We use technologies such as platelet-rich plasma, or PRP, to improve the skin quality and have found that PRP does have a value in expediting healing. Most of our patients return to work in a week with minimal bruising and swelling. It is important to recognize that when you have injectable fillers, depending on the practitioner, you may still experience bruising and swelling which I would say is comparable to the trauma of traditionally performed cosmetic eyelid surgery. If you look at your timeframe,your schedule, as well as the pros and cons of the expenses and time allocated for injectable fillers, you may find yourself deciding that the more practical solution would be to undergo lower eyelid surgery.
In addition, the approach I would typically would use with someone of your age would be a technique called a transconjunctival blepharoplasty, which means I’m addressing the fat pockets from the inside of the eyelids. This contributes to the minimal trauma which results in minimal swelling and bruising afterwards.
I recommend you meet with qualified, experienced surgeons who perform both cosmetic eyelid surgery and injectable fillers, and learn about the option of having the procedure done under local anesthesia with LITE™ sedation. Get an understanding of what your expected healing process could be like. Ask the doctor to show photos of patients, and how they appear after one week. Thank you for your question.

Dear England,It appears from your photos that you have orbital fat pushing forward into your lower eyelid region. This can make a person appear tired or sick or old even when they feel fine inside. There are surgical options to help. Best to seek out an Oculoplastic Specialist in your area. I hope this was helpful. 

You should have an in-person consultation to determine the best approach. The filler in the under eye can last 1 year, but if you don’t like it then it can be completely dissolved! See an expert! Dr. Aldo