I want to give myself a more youthful appearance. Should I have upper eyelid surgery or filler in tear trough? (Photo)

I am getting older and I want to give myself a more youthful, refreshed appearance. I do not want to do too many things at once, so I need some honest advise on which route to go. I am considering upper eyelid sugery for somewhat droopy eyes or restalyne in tear troughs possibly combined with voluma in cheeks. I have attached 2 photographs. Please be honest. This is my face. Thank you!

Doctor Answers 10

Combined Approach Can Produce Great Results

I think you are definitely on the right track with the treatments you're considering. Combining upper blepharoplasty with fillers for your lower eyelids can produce excellent aesthetic results when performed by an experienced facial plastic surgeon. And using JUVÉDERM VOLUMA XC to restore some youthful volume to the cheeks will complement the eyelid procedures. Combining all of these treatments during a single visit is common and should give you the refreshed appearance you desire. Best of luck!

Toronto Plastic Surgeon
4.8 out of 5 stars 9 reviews

Upper Blephs and filler

Good Morning A.G

Thanks for posting. It may be worth getting filler for the troughs as this is less invasive and should give a step up from where you currently are. You can also try PRP.

PRP: Platelet Rich Plasma involves the injection of a patient’s own plasma and growth factors in to targeted areas by a cosmetic specialist. The small injections of PRP can significantly improve the appearance of skin by regenerating collagen production, which can assist in adding volume, improving fine lines, scar improvement. PRP can also address the dark areas under the eyes.

If this sorts it and your happy with the result then great. If not, then you would benefit from upper blephs surgery.

Upper lid blepharoplasty is a very common cosmetic surgery procedure in the UK. The aim of eyelid surgery is to remove excess kin and/or fat deposits to leave the upper lid skin tighter and fresher in appearance. Discussing the pros and cons of eyelid surgery with a PS would be the best option.

Lower eyelid surgery aims to address the bags under the eyes. Excess skin and removal or reshaping of the fat smooth’s the contour between the lower eyelid and the cheeks. Your cosmetic surgeon will assess if the procedure can be performed under local anaesthetic.

All the best

Amir Nakhdjevani, MBBS, MRCS, FRCS (Plast)
London Plastic Surgeon
5.0 out of 5 stars 44 reviews


The upper blepharoplasty does not fix the tear troughs since they are next to the lower eyelids. In your case you still have some excess skin in your upper eyelids that can be removed with the upper blepharoplasty. What you have under your lower eyelids are fat pads that are protruding and they are the ones that give you that look. Fillers are a minor band-aid since what they do is fill the crease under this fat pads so they don't look so big. This is a mistake since they will make your face look swollen. The Best option is to simply remove this fat pads and the excess skin in your lower eyelids. What you need is an upper and lower blepharoplasty. Hope this answers your question.

Luis Pedroza, MD
Colombia Facial Plastic Surgeon
5.0 out of 5 stars 2 reviews


I agree an upper lid blepharoplasty would be perfect for your upper eyelids.  Fat grafting or a thin HA filler like Belotero for the lower eyelid tear trough would be a nice adjunct.  

Under eye fillers are non-surgical and an easy service to have.

The key with under eye filler is finding the right injector.  The service is fussy.  However, it will immediately make you look better when the treatment is done correctly.  The upper eyelids demonstrate upper eyelid ptosis.  You need a structured anchor blepharoplasty with ptosis repair.  That means expert aesthetic eyelid surgery at a level of detail that is often hard to find.  Many eyelid surgeons are not trained to repair the upper eyelid ptosis.  Do your homework on providers.  Below is my free ebook on eyelid surgery which discusses these procedures in detail.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
4.9 out of 5 stars 23 reviews

Upper eyelids and tear troughs

Addressing the upper eyelid excess skin via a blepharoplasty and the lower eyelid tear troughs with fillers is a great combination of treatment to give the eyes a more youthful/ "rested" appearance.  They each--in and of themselves--provide nice, subtle results to the eyes.  Results from the combination of these procedures while subtle do a very nice job of rejuvenating the eyes.  


Often, the hollow below the lids is due to loss of upper malar or cheek volume.  With this loss of fat and deeper supporting tissues the tear trough hollow below the lids are evident.  Filling the cheeks with Radiesse will lift these structures and create a normal contour.

Droopy eye appearance

You would help yourself best with upper and lower eyelid lift. The lower lid change combined with a mid-face lift through the lower lid incision that would fill in the trough without the need for fillers. 
Discuss this with your board certified plastic surgeon. 

Leon Goldstein, MD
Madison Plastic Surgeon
4.6 out of 5 stars 11 reviews

Upper eyelid plasty or filler?

The patient leaves the question not in an either or sense but in fact a graduated attempt to improve her appearance. I would certainly agree with this even though the two procedures, blepharoplasty and tear trough filler are quite different. The question, posed in that context I would suggest doing the upper eyelids first as I see a greater need for that. This is a simple, straightforward procedure. Although fat grafting of the lower lids has been suggested I generally am not in favor of that because of the potential for lumpiness. In addition hyaluronic acid, such as Juvederm Restylane can easily be reversed.

Richard O. Gregory, MD
Orlando Plastic Surgeon
5.0 out of 5 stars 11 reviews

Bleph or fillers

After looking at your photos for sure an upper lid bleph will clean up your upper lid skin excess but rahter than fillers I prefer to use a patient's own fat to add volume to your face but it is a docs choice.

Robert Brueck, MD
Fort Myers Plastic Surgeon
5.0 out of 5 stars 54 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.