Lower blepharoplasty with filler or fat transfer? (Photo)

Question

I'm interested in getting surgery done to improve my dark circles/eye bags that I've had since I was young. I've seen several oculoplastic surgeons who've suggested different treatments and I can't decide which would be better: • Lower blepharoplasty with tear trough filler afterwards • Lower blepharplasty with fat transfer to the tear trough Attached are some photos of my eyes. Which would result in a better outcome?

Mehryar (Ray) Taban, MD, FACS · Answer

The gold standard is transconjunctival lower blepharoplasty (with eye fat bags repositioning). Fat injection is unpredictable. See an expert.

Jason Emer, MD · Answer

For unique cases where a variety of modalities could be used to treat the condition, I would suggest an in-person or virtual consultation to develop a custom and effective treatment plan.  It is difficult to precisely define the best option without collecting the same information. I suggest reaching out to an expert for a consultation with surgical and non-surgical methods to get a comprehensive option. Best, Dr. Emer.

Brooke R. Seckel, MD, FACS (retired) · Answer

Thank you for your question and photographs.

Filler injection into the eyelids poses a risk of blindness although rare.  As important filler injections in the lower eyelids to correct dark circles often is not placed properly and the action of the lower eyelid muscle pushes the filler out of the depression or shadow and actually makes the dark circle worse.

A procedure called a transconjunctival lower blepharoplasty with arcus marginalis release and fat grafting is an effective permanent solution to correct dark circles under the eyes.

It is important to understand that composite fat grafting, the actual placement of a fat graft into the area of depression causing the dark circles is necessary.  You will read about fat repositioning but I gave that procedure up many many years ago because repositioning fat and leaving its connection to the blood vessels intact can result in the fat retracting and losing the effect to correct the dark circle.

Lower blepharoplasty with filler or fat transfer? (Photo)

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