Filler Under Eyes VS Lower Blepharoplasty? (photo)

Question

I am a 32 year old female and looking for the best treatment for under eye hollows/wrinkles. I went to a derm to discuss fillers. To my surprise, she recommended a lower blepharoplasty instead of fillers. With work, surgery really isn't an option. Is there ANY filler that will treat under eye hollows/wrinkles? If so, is it better to inject them into the cheeks or tear troughs?

A.J. Amadi, MD · Answer

Both fillers to the tear trough/cheek and lower lid blepharoplasty with fat repositioning are valid options. If taking 1-2 weeks off from work is not an option for you, then fillers are the way to go. Juvederm, Restylane, or Boletero can be used in this area. A combination of injection to the tear trough and the upper cheek would give you the best outcome.

Luis Villar, MD, FACS · Answer

A thorough physical examination (touch and feel) is essential to determine the  appropriate technique suited for each individual patient.  Poorly lit photos will generate a lot of bad advice.    Do not waste your time with fillers.  It is always better to do the best procedure that deals with the problem and get it right the first time.  

	In skilled hands you could reasonably return to work in one week.  Full unrestricted activity is typically at three weeks.   Best wishes.  Knowledge is power.  Luis F. Villar MD FACS

Houtan Chaboki, MD · Answer

A common question to lower eyelid area cosmetic improvement. Generally, there are a few options to improve the appearance of the lower eyelids, eye bags, or dark circles. First option includes basic skin care, tretinoin, and/or chemical peels. This nonsurgical method helps improve the skin quality, reduce pigmentary changes, and improves overall appearance of the lower eyelid & cheek areas.

	Second more advanced option is an injectable filler or fat to plump up the area. Fillers are made of material that slowly dissolves over time. Facial fillers treatment is performed in the office vial local anesthesia. Hyaluronic acid fillers, such as Restylane or Belotero, have been used to smooth the lower eyelid area. Facial fillers for lower eyelid area are typically placed in the "valleys" or depressions of the eyelid. Results last several months or year.

	The last option, and also the most aggressive, is eyelid plastic surgery. Cosmetic surgery of the lower eyelid may remove or reposition fat in the eye bag area, and possible remove some sagging skin. Plastic surgeons typically don't recommend cosmetic eyelid surgery in young patients. However, each patient is unique and circumstances may vary. Age alone is not a determining factor if a person is a cosmetic surgery candidate.

	Only after a comprehensive evaluation can a specialist help determine appropriate options for you. Best of luck.

Robert F. Centeno, MD, FACS · Answer

Both surgery and fillers are options. A transconjunctival blepharoplasty...an incision on the inside of the eyelid to remove the fat pocket would work well for you.  Your recovery should not be too bad.  Alternatively, a filler such as Radiesse to the cheeks and Restylane to the lid cheek junction and tear trough would help significantly.  All the best.

Steven J. Covici, MD · Answer

Based on your photos, I think you would do best with a blepharoplasty.  It will give you a better result and ultimately be more cost effective.  Find a surgeon who will do a fat transferring technique which will transpose fat into your tear trough.  Hope this helps.  

	 

	Steven Covici, MD

Michael I. Echavez, MD · Answer

I do not see much in the way of wrinkles under your eyes, but you do have some protrusion of fat which is causing the puffiness and then an area of depression underneath it. Your options would be to have surgery to deal with the fat or to use a filler, like Restylane, to treat the area of depression and improve the area. The improvement from the Restylane would be temporary.

Edward Szachowicz, MD, PhD · Answer

The cheek begins to drop and the smooth fat under the skin begins to thin with age. Restoring volume to the cheek area is a good way to rejuvenate the upper face.

	Sculptra is a filler which promotes new collagen to form, and lasts longer than gel fillers. I have seen gel fillers cause puffiness in the under eye area, so I recommend being conservative around the eyes with gel fillers.

Jessica Kulak, MD · Answer

Both a lower eyelid surgery and fillers could be helpful in improving the appearance of your lower eyelids. The fillers, such as Restylane or Belotero are temporary lasting 6 months to a year. Filler injections to the tear trough area and along the orbital rim would soften the appearance of hollowness around your eyes. A lower eyelid surgery or blepharoplasty would be helpful to smooth the eyelid "bags" or fat that is appears to be protruding in the lower eyelid area. This can be done through an incision inside your eyelid with around 1-2 weeks of downtime from work. Choosing the "best" procedure for you depends on many factors including your personal goals as well your current lifestyle and work limitations. If now is not the time for surgery, then fillers are a great temporary option that would provide a nice improvement until your ready for surgery.

Stephen Weber MD, FACS · Answer

Both filler and lower blepharoplasty are reasonable options to improve your lower eyelids. Surgery will require about 7 days of downtime to recover from any swelling or bruising but will give you a long-term improvement in the lower eyelid bags. Filler, on the other hand, has minimal downtime (any bruising can be covered up immediately with makeup) but is temporary lasting from 6-12 months. Both options will work well for you. I hope this information is helpful.Stephen Weber MD, FACS

Curtis Wong, MD · Answer

If you want something more permanent, then a surgical lower lid blepharoplasty would be best approaching this from inside the eyelid with the bag transposed over the orbital rim. If you're okay with temporary treatments, you can consider filler in the troughs. As an alternative, you could consider fat grafting if you're willing to accept the risks of fat grafting. The answer all depends on what you are wanting to do and what costs and risks you are willing to accept.

Filler Under Eyes VS Lower Blepharoplasty? (photo)

Answers (12)

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