Filler Under Eyes VS Lower Blepharoplasty? (photo)

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?

Doctor Answers 12

Fillers vs fat repositioning

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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.

Seattle Oculoplastic Surgeon
5.0 out of 5 stars 41 reviews

Filler Under Eyes vs Lower Blepharoplasty

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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.

Surgery vs filler

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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. 

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Transconjunctival Blepharoplasty or Fillers

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Both surgery and fillers are options. A transconjunctival 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.

Lower Lid Blepharoplasty

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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

Both filler and lower blepharoplasty are reasonable options to improve your lower eyelids

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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

Best procedure for lower lid bags

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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.

Fillers for tear trough deformity

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Fillers is always a better option for tear trough deformity. Blepharoplasty can't correct this problem. Fat or radiesse carefully implanted by a talented physician is your best option. The creepiness is caused by loss of volume

Lewis M. Feder, MD
New York Dermatologist

Fillers versus blepharoplasty for lower eyelids

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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.  

Michael I. Echavez, MD
San Francisco Facial Plastic Surgeon
4.5 out of 5 stars 18 reviews

Fillers NO byVillar

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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

Luis Villar, MD, FACS
West Palm Beach Plastic Surgeon
4.4 out of 5 stars 11 reviews

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.