Filler Under Eyes VS Lower Blepharoplasty? (photo)

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.

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

I’m impressed that the dermatologist recommended blepharoplasty. In my area in Upper East Side Manhattan and in Garden City, Long Island, there are lots of non-surgical physicians who try to address under eye bags by adding volume. Unfortunately, a lot of these efforts are very misguided.

Anatomically, facial aging, which I actually wrote in my book “The Fine Art of Looking Younger”, is a couple of different processes that includes volume loss. When I do an evaluation of the eye area, I always look at the eye and the cheek because there is a relationship between the aesthetics of the eye and the cheek area. As we get older, the tissue gets thin, and trying to fill thin tissue to compensate the loss of bone, muscle and fat may soften the area of contrast between the eyelid and cheek, which makes a lot of people look very strange. In fact, a significant number of patients come to our office every week to have their Restylane and Juvederm filler placed in their tear troughs removed, which we do with an enzyme called hyaluronidase in order to stop their eye bags from looking even worse.

Clearly there’s puffiness under your eyes and that puffiness is called lower eyelid fat prolapse. This means that the fat normally behind the eye pushes forward and creates a hill. This hollow is actually the contrast between the high hill and the valley of the tear trough that makes it look deep.

20 years ago, I was determined to help people who don’t have time to recover from eyelid surgery get back to normal life as quickly as possible, so I developed a particular style and process of doing eyelid surgery that is called a quick recovery approach. For the right candidate, we can do a procedure on a Thursday or even Friday and reduce the puffy bags under the eyes and allow them to get back to work on Monday. We use the weekend as a big part of the healing process. Day by day, a little bit of fluid and swelling resolves and nobody knows what’s going on until you look better.

I suggest that you shouldn’t completely take out the option of having surgery because there are techniques that allow people to recover quicker than you expect. These include surgical technique, anesthesia and the after care. The puffiness under your eyes is so significant that your dermatologist thinks that softening the tear trough would probably not make enough of a difference in compensating the puffiness. You may want to save your money and wait for the right time to do the lower eyelid surgery first and maybe combine it with something to address the eyelid cheek hollowing in the future. I hope this was helpful, and thank you for your question.