Should I get filler injections or a lower blepharoplasty with fat repositioning and a skin pinch? (Photo)

I am 40 years old and I am considering a lower blepharoplasty. After lots of research ,I am unsure if I should have filler injections instead or proceed with a transconjunctional blepharoplasty, with fat repositioning and a skin pinch . One of my main concerns is the long term effects of the surgery in terms of looking hollow. I would appreciate any feedback.

Doctor Answers 12

Lower blepharoplasty

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 We do not recommend fillers and lower lids. When herniated fat bags are present  In the lower lids, and then a transconjuntival approach for a conservative fat removal is performed. When excess skin is present on the lower lids, a pinch technique is performed and the incision closed with tissue glue.  For many examples please see the link below

Tear Trough Treatment vs. Lower Blepharoplasty

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The more permanent solution would be a lower blepharoplasty with skin pinch; however you can move forward with either a surgical or non-surgical approach.Your concern about long-term hollowness is quite appropriate.In the past, many lower eyelid blepharoplasty procedures were performed with overly aggressive removal of lower eyelid fat.While these patients may have look quite good immediately after and even perhaps for some years after their surgery, over the longer term they could look hollowed.The key is to remove a very conservative amount of fat.During Tear Trough correction, a filler (usually Restylane) is injected underneath the skin to fill in hollowness and darkness.This non-surgical procedure lasts approximately 18 months.In order to determine which option is best for you, I suggest speaking with a board certified plastic surgeon, facial plastic surgeon or oculoplastic surgeon to weigh the benefits of both procedures. If you find a skilled and experienced surgeon, you should not experience any hollowness after surgery.The benefits of lower blepharoplasty surgery can last anywhere from about 10-15 years.I hope this information is useful.

Should I get filler injections or a lower blepharoplasty with fat repositioning and a skin pinch?

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Yes a lower lid blepharoplasty with canthopexy + fat grafts or fillers to tear trough. Seek in person opinions...   

You should do well with a transconjunctival fat repostioning.

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If you do not want surgery you could make the lids look better by filling in the tear trough.  The filler should last about a year.  A more permanent approach would be the surgery. I would not do a fat excision bleph as this will make the tear trough appear deeper, with darker circles under the eye.  From the photos it looks like you would have enough fat to fill in the tear trough by repositioning it into this area.  A pinch of skin helps to smooth out the skin.   

Lower eyelid rejuvenation

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The lower lids are a frequent cosmetic concern. Unwanted wrinkles, grooves, and bags can form making you look tired. A natural look can be obtained with fillers (either hyaluronic acid fillers or fat harvested from your body) or with fat repositioning. I prefer the transconjunctival approach to repositioning of the fat and with a skin pinch to avoid hollowing and minimize the risk of complications.

P. Daniel Ward, MD
Salt Lake City Facial Plastic Surgeon
4.9 out of 5 stars 49 reviews

Should I get filler injections or a lower blepharoplasty

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The answer is "both". With your anatomy which appears to be very flat below the lower rim of the eye, you need both fat repositioning and then at a later date fat grafting to give contour.

You have significant eye changes for your age.

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Agree with Dr. Taban.  You have both upper and lower eyelid issues.  The upper eyelid have anterior levator dehiscence ptosis with significant hollowing of the upper eyelid sulcus.  The lowers might benefit from fillers but this will be fussy.  I think you might do well proceeding with lower eyelid surgery but it is essential to find a surgeon who is very artful.  Your lower eyelids need fat repositioning that is most safely performed transconjunctivally.  You also need a transcutaneous skin only dissection to help resuspend the lower eyelid orbicularis and remove a tiny amount of lower eyelid skin.  The risk is that many surgeon will want to accomplish this surgery simply by performing an infracilliary transcutaneous lower bleph where the skin and muscle is cut to gain access to the lower eyelid fat.  Because you have a big eye socket, the motor nerve damage that this type of surgery will cause is likely to cause late lower eyelid issues.  I suggest that you proceed cautiously can get many opinions to decide who makes the most sense.  Sometimes it is worthwhile to travel for the right surgery.

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

A different approach

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Another approach to consider is a lower lid transconjuntival bleph but combine it with a fractional CO2 laser. Less down time and less risk from lower lid malpositioning.

Lower blepharoplasty vs filler

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You are a good candidate for the surgical option as it is more long-term. You should also consider upper lid ptosis surgery; discuss it with your surgeon or oculoplastic surgeon.

Lower lid surgery or filler injection

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Go for the lower lid blepharoplasty with fat repositioning if you can afford it. The results are longer lasting and almost always look better than filler injection. With surgery you can get rid of the bulge, not so with fillers. While fillers may look good at rest, with certain movements such as smiling, sometimes the filled area looks like a bulge.

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.