Eyelid Surgery And/or Injections ? (photo)

I am a 38 yr old male who has had a tired appearance under my eyes since I was in my mid twenties. I have a high cheek bone under my eyes. I am considering upper and lower (lower most importantly) eyelid surgery, but money is a factor so I'm saving. In the mean time, I'd like to improve my appearance for less $ and was told by one physician that injections could take care of the lower tired look, but it's not permanent. I am interested in doing this, and having my laugh lines filled in, then in a

Doctor Answers 9

Eyelid surgery or other options

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Certainly a lower eyelid procedure to conservatively remove fat and blend the lower lid cheek junction would be ideal.  Fillers can also be used to soften the look.

New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Eyelid Surgery And/or Injections ?

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Eyelid surgery will remove the lower eyelid bags however for a temporary fix, you can have either Restylane or Juvederm injected along the leading edge of the fat bags to taper and hide the effects, of the bags.  The nasolabial folds respond better with a thicker filler, like Perlane IMHO.  IMO, your cheeks are quite flat and you could really improve your appearance with Perlane or Radiesse that aesthetically shapes the cheeks.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Surgical and nonsurgical options for tired eyes

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Your pictures are quite typical for someone requesting cosmetic treatment for tired eyes. There are surgical and non-surgical options available to you and there are benefits to both. As we age the lid cheek junction becomes exagerrated as the fat around the eye begins to bulge and the cheek fat begins to sag. This causes the undereye area to look heavy and tired. Options to correct this involve a lower lid blepharoplasty with conservative fat excision versus fat repositioning. In someone requesting a cheaper yet "reversible" fix then injection of a hyaluronic filler into the tear trough to smooth out the volume loss here is a great option. Injections of this type last around a year or longer and the introduction of blunt tip cannulas has greatly reduced the swelling and bruising previously seen in my practice. 

Giancarlo Zuliani, MD
Rochester Facial Plastic Surgeon
5.0 out of 5 stars 71 reviews

Filler for dark circles

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Yes, lower eyelid filler (Restyalne) can help with your dark circles by filling in the hollow area underneath your lower lids. The effect can last one year or longer.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 91 reviews

Tired looking eyes and their treatment.

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You have several issues. Excess fat bulges of the lower lid can be improved by removal and transfer into the groove below. Alternatively, Juviderm can give some improvement by filling the groove. A midface lift may be indicated but you cannnot tell from the photos. See an experienced surgeon who gives you the pros and cons of several ways of dealing with this.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 38 reviews

Eyelid or blepharoplasty and fillers

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there are always more than one option for treating problems depending on budget, healing issues, etc


  1. juvederm can be used as a temporary filler ,  its cheap and easy and can be dissolved if you dont like it
  2. if it works and you like it   fat can be used for the next treatment
  3. fat repositions and muscle suspension with or without filler is probalby best
    1. this is more expensive
    2. longer to heal
    3.  will give the best result

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 116 reviews

First it is essential to understand that less is more.

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You have heavy upper eyelids.  You have very big eyes.  Lower eyelid surgery will be a great concern for you because of the risk of post-surgical lower eyelid malposition: Big eyes=big trouble.  MIdface surgery and fat grafting should be considered experimental.  Please don't let surgeons experiment on you.  The fillers are an excellent option because products like Restylane and Perlane can be adjusted after they have been placed.  There is not permanent when it comes to these issues so don't be afraid of a solution that may only last a year or two.  I think that fillers tend to be a very good place to start.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Surgery vs. Injections

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In some situations injections can help achieve goals that are difficult to reach via other techniques including surgery.  The question then becomes whether you are a candidate for injections or not.  "Tired" is a very subjective term when it comes to describing one's appearance and it may mean different things to different people.  The best way to determine your ideal options is toshow your doctor some old photographs where you felt as if you looked rested.  The changes that took place since the photo was taken can then be assessed and a plan made to correct them.

Brian Biesman, MD
Nashville Oculoplastic Surgeon
4.8 out of 5 stars 43 reviews

Blepharoplasty is not the only option for "tired eye"

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Thank you for the photo.  You appear to have typical changes of the lower eyelid for a 38 year old. 

  1. The area below your lower eyelids , sometimes called a tear trough is classically an area that bothers people.   Although traditionally, this are was treated with blepharoplasty, this area can be improved with several other options.
  2. A midface lift can improve  the cheek/eyelid junction.
  3. Fat transfer to this area can be very carefully performed. 
  4. Fillers are being used more and more in this area for a temporary, but excellent outcome. Best Wishes

Travis T. Tollefson, MD, MPH
Sacramento Facial Plastic Surgeon

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.