Would under eye filler or blepharoplasty be a better option for my tired looking eyes? (Photo)

Rosepetal,
Your under eye bags are likely due to fat around your eye pushing out. This happens as people age. Another part of the problem is fat volume loss in your cheeks, as the cheeks descend from volume loss the bags become more apparent.
I would definitely recommend a lower blepharoplasty to address the lower eyelid fat issue. Placing filler in the cheek region could help as well.
I think the best option for you would be to perform a lower blepharoplasty with facial fat grafting to the cheeks. This acts as permanent filler which will help revolumize your cheeks. It could be done in the same operation.
Hope this helps-Joshua Halka MD

Hi @Rosepetal83. Based on your photos, you have bulging of the fat pads involving your lower eyelids. You are a great candidate for a lower blepharoplasty. You may require a skin tightening procedure like Morpheus 8 post-op.

Best of luck,

Dr. Nima

The eye area needs significant combinations to get improvement. Lasers like erbium, co2, halo, profractional/contour, or Fraxel can all be used to build collagen long term. Plasma pen is a newer less invasive option but will take many treatments and require proper skincare. Plasma Pen is focused electrical plasma energy to tighten skin, producing small columns of energy just above the skin, allowing the skin to tighten to help improve wrinkles. This area will have 3-5 days of small “dots” that will then scab and peel, then the skin will tighter and brighter after. Numerous treatments are needed over lasers where only one or two give a bigger result, but more downtime. After plasma pen you NEED peels 2 weeks like later Cosmelan, enlighten or aerify, see emeragecosmetics (link). At home derma rolling should be started weekly even after plasma pen or lasers to further increase collagen, see emeragecosmetics AERIFY x anteagemd stem cell ampules. To properly heal you need light Stim red LED, EmerageSkin refit face, refit eye; AnteageMD serum, silagen silicone gel, jan Marini bioshield, EmerageSkin enzymatic polish, and EmerageSkin hyla b and AOX, and Sente dermal repair. Otherwise there is EXTREME risk of pigmentation issues and “dots” in the treatment area. at home peels like cosmelan, enlighten and aerify along with dermarolling (AERIFY emerageskin roller with Anteage MD ampules) should be started now regardless for antiaging, sun damage, and wrinkle prevention. There are many things you can do to treat under eye hollows and dark circles. A surgical option to remove skin and/or fat will such as eyelid blepharoplasty with or without fat pad repositioning (if doing lower eyelid surgery) will be the best long term. There are many things you can do to treat under eye hollows and dark circles without surgery. Non invasive less downtime options such as fillers, lasers, microneedling/PRP, cosmelan peels, and microneedling RF like Fractora, PiXel8 or morpheus can all help give some improvement. Accutite can often be used or stronger lasers like erbium or co2 spot treatment can tighten the skin and give very quick improvement in wrinkles and texture. I suggest you get a formal consultation to see what is best for you and your goals. Best, Dr. Emer.

You appear to have significant bulging of the fat pads involving your lower eyelids. Depending on your examination, a transconjunctival lower eyelid blepharoplasty procedure may be considered for removing those fat pads without an external scar. Post-operatively, Morpheus8 treatments may be considered for achieving Less wrinkling of your under eye skin: only if it becomes more prominent. I hope this helps! Sincerely, Dr Joseph

Surgery would be overkill for what you have and fillers are not the best options for under the eyes as they can lead to complications such as lumpiness, discoloration and swelling. My favorite treatments for this condition are and autologous fat transfer or PRP plasma gel.

Hi @rosepetal83, it looks like you may have a component of pseudo-fat herniation of the ocular fat pads. I recommend a consultation with a facial plastic surgeon. Best of luck, Dr. Ghazizadeh

The choice between under-eye filler and blepharoplasty (eyelid surgery) depends on several factors, including your specific concerns, the underlying causes of your tired-looking eyes, and your overall goals. Here's a brief overview of both options:1.) Under-Eye Filler:• Purpose: Under-eye filler injections are typically used to address hollow or sunken areas under the eyes, which can contribute to a tired appearance.• Procedure: This non-surgical procedure involves injecting a dermal filler, such as hyaluronic acid, into the under-eye area to add volume and smooth out wrinkles.• Results: Fillers can provide immediate results with minimal downtime, and they can make the under-eye area appear more refreshed and youthful.• Duration: The effects of under-eye fillers are temporary and usually last around 6-12 months, depending on the filler used.2.) Blepharoplasty (Eyelid Surgery):• Purpose: Blepharoplasty is a surgical procedure that can address various issues related to the eyelids, including excess skin, fat, and muscle. It can be performed on the upper eyelids, lower eyelids, or both.• Procedure: During blepharoplasty, excess tissue is removed, and the eyelids are reshaped to create a more youthful and rested appearance.• Results: The results of blepharoplasty are long-lasting, and the procedure can provide more significant changes to the appearance of the eyes compared to fillers.• Downtime: Recovery from blepharoplasty typically involves more downtime compared to filler injections, and there may be some bruising and swelling.Here are some factors to consider when making your decision:1.) Severity of Concerns: If your main concern is hollowing or volume loss under the eyes, fillers may be a suitable choice. However, if you have excess sagging skin, muscle laxity, or prominent fat pads, blepharoplasty may be more appropriate.2.) Longevity: Fillers offer temporary results and require periodic maintenance, while blepharoplasty provides more lasting results.3.) Cost: Fillers are generally less expensive than surgery, but the cost can add up over time due to the need for repeat injections.4.) Surgical Risks: Blepharoplasty is a surgical procedure with associated risks, such as scarring and anesthesia complications. Non-surgical fillers have fewer inherent risks.5.) Consultation: It's essential to consult with a board-certified plastic surgeon or dermatologist who can assess your specific concerns, examine your anatomy, and provide personalized recommendations based on your goals.Ultimately, the decision between under-eye filler and blepharoplasty should be made in consultation with a qualified medical professional who can help you weigh the pros and cons and choose the best option for your unique situation. They will consider your aesthetic goals, medical history, and the condition of your eye area to guide you toward the most suitable treatment.

Hi there! Thank you for your question. You appear to have a couple of things going on under your eyes. The first being minor fat pad herniation, and the second is volume loss. The fat pad herniation is treated with a lower bleph, and the volume loss with filler. It is not unusual for patients that have lower bleph surgery to come in for filler after they have healed. These are two solutions for two different problems.
That said, when patient's have very mild herniation, or cannot have surgery for any reason, we can use filler to camouflage the fat pads and make the area appear more smooth.
You can see examples of this work on our website. Good luck!

There are a few options available to improve the under eye area. The best one depends on your goals for treatment. A lower blepharoplasty surgery would give permanent improvement but is the most aggressive. Fillers can provide improvement with no down time but the results are temporary. A third option is AccuTite which uses RF technology to improve and tighten skin. See a board certified plastic surgeon to learn more.

Loss of volume under the lower lids can be a common issue seen with aging. Fortunately, you have several different options at your disposable depending on the desired results and your budget. Since your skin seems to be suffering from relative laxity under the eye I would recommend starting with a filler under the eye. This could range from PRP to autologous fat transfer to a dermal filler. Autologous fat transfer with or without PRP combined will likely give you the look you're trying to achieve with the most longevity for the cost. Surgical blepharoplasty is a lot more invasive and expensive and seems unnecessary when you can achieve excellent results through so many other means. In addition if you wanted to address skin texture or tightening issues after tear trough injection non-surgical blepharoplasty with a device like a plasma pen or RF device can help as well as micro needling.