Lower Blepharoplasty Vs Restylane Under Eyes? (photo)

I am a women early 40s, below my eyes has gotten noticeably puffy. I was recommended a lower bleph to remove the fat under my eyes, hospitalization required. When I was hesitant to do that I was recommended upper skin Bleph in office. I like both ideas. Can both be done in office? Was also recommended via email to get Restyline by another surgeon. After reading all of the review seems like there is a 50/50 chance for a mishap. Any and all advice will be greatly appreciated. Thank you!

Doctor Answers 11

Filler or lower lid lift

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Thank you for your question about blepharoplasty versus filler.

  • a lower lid lift with release of the orbital septum, TCA lid peel and fat transplants or filler at the crease would be ideal. 
  • I routinely do upper lid lifts in the office,
  • I prefer to do lower lid lifts in an outpatient operating room, not a hospital,
  • fillers alone will be temporary and results not as good,
  •  your upper lids? Only have them done if you don't like your sultry look. Otherwise I might wait. Hope this helps. Best wishes.

Blepharoplasty NOT Filler

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Thank you for your photos.  If there are no medical reasons for your puffiness and that has been documented then I would NOT recommend a filler to improve the issue.  I would recommend a lower lid blepharoplasty.  My approach would depend on an exam as would my recommendation for an upper blepharoplasty.  Your upper lids appear fine in the photos.  The procedure can be performed in an accredited office based OR unless you have  some medical issues that warrant a hospital environment.

Dr. ES

FIllers vs lower blepharoplasty

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Judging from your photos, you would likely get a good result from either treatment. They fillers would be entirely nonsurgical, but may still bruise for several days if you're unlucky. Results are good for about a year.

Surgery would require 1-2 weeks of recovery, but many surgeons would be able to do it without hospitalization, in an office-based surgical suite. Results would be much more longlasting.

Laxmeesh Mike Nayak, MD
Saint Louis Facial Plastic Surgeon
5.0 out of 5 stars 230 reviews

Restylane or surgery

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This is an excellent question and a dilemma faced by many potential patients. The goal of either procedure would be to improve the transition between your lower eyelids and cheeks to give you a smoother contour, lessening the appearance of "bags" under the eyes. The main goal of lower eyelid surgery would be to reduce the puffiness in your lower eyelids by removing fat. Restylane would be used to reduce hollowing under the "bag" by plumping the underlying tissue. It is hard to tell how puffy the lower eyelids are from your photos. Overall, it looks like the hollowing in the tear trough is more of a problem than excess fat in the lower eyelids. As long as the skin around the area of hollowing is thick and strong, I would probably recommend Restylane injections for you over lower eyelid surgery. If you did have fat removed from the lower eyelids, you will still have hollowing along the orbital rims and will likely need a secondary procedure to improve the hollowing. Some doctors would move fat to the hollow area at the time of eyelid surgery, but I prefer to wait until several weeks after surgery and add Restylane to this area as a secondary procedure. In my experience, this method produces the best result, but other doctors will have their own methods that they like best. I also think you need some volume in your upper cheeks to optimize the eyelid-cheek junction and therefore optimize your results. I would also use filler injections to add volume to your cheeks, but prefer to use Juvederm in this area over Restylane. My overall sense is that your midface needs volume, so I would prefer addiing volume with fillers over subtracting volume with conventional blepharoplasty surgery. I would look for a doctor who has a lot of experience with under eye fillers as well as eyelid surgery. Best of luck!

Mitesh Kapadia, MD, PhD
Boston Oculoplastic Surgeon
4.9 out of 5 stars 182 reviews

Surgery or Fillers for Puffiness on the Lower Eyelids

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Thank you for your question. Your problem is not unusual and it is good to have alternative options to surgery. Fillers like Restylane or Juvederm will camouflage the problem temporarily, up to about 12 months on average, by smoothing the area between lower eyelids and malar area (upper cheek).

A lower blepharoplasty would be able to address the problem more radically and the result would be long lasting.

My advice is to see a plastic surgeon and to ask him to guide you in making the most appropriate decision for your specific case.

Good luck.

Andrea Marando


Andrea Marando, MD
Manchester Plastic Surgeon
5.0 out of 5 stars 128 reviews

Lower Blepharoplasty Vs Restylane Under Eyes?

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 From the photos provided, there does appear to be some lower eyelid fat which can be removed with a lower eyelid surgery (Blepharoplasty).  This takes about 30 minutes and is a minor surgery that can be performed as an outpatient basis.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Better candidate for for surgical correction and rejuventation of the lower eyelids

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If you are seeking improvement and rejuvenation of the lower eyelids then there are two methods, surgical and non-surgical. Non surgical improvement consists of soft tissue fillers such as Juvederm. In addition to soft tissue fillers you may consider microablative fractionated CO2 laser treatment such as SmartSkin and SmartXide will help to tighten the skin. These can be performed in combination.  With the degree of puffiness you have of your lower eyelids I would recommend surgery over non-surgical methods.  This would include repositioning of the fat to fill in the deep tear trough grooves and elevation of the lateral malar pad to fill in the lateral portion of the orbit.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

Eye bag surgery will give you a better look and is more permanent. It can be done safely as an outpatient in a private facility

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After looking at your photos, I can see that there is excess skin in your upper lids and in your lower lids, there’s a good amount of fat prolapse which we refer to as herniated fat. In the past couple years, injectables have been used to try to camouflage the appearance of herniated fat. People come to our office for a resolution because they have used Restylane and Juvederm under the eyes to try to hide the fat, but they end up with more swelling that makes the fat pockets look even bigger. In your case, I can assess that you are really a good candidate for lower eyelid blepharoplasty.

In my practice, we do our procedures in our own private facilities in both of our offices and we are joint commission certified. One of the reasons of having a private facility is safety. Doctors like to practice in facilities like hospitals or service centers because there is an added level of safety such as sterility. The key thing is that you want to be sure about the procedures that affect your physical health. We created the facility and the systems so that a person can come to us and have the procedure with personalized care.

What we do for someone like you is do the eyelids under local anesthesia with light IV sedation. That basically means getting a little liquid valium intravenously for relaxation and don’t you have to go to the hospital. You go home the same day and do some basic aftercare such as applying ice or cold compresses to your eyes.

After that’s done, it doesn’t mean you won’t need any kind of fillers or anything that helps volume. In my book called “The Fine Art of Looking Younger”, I teach my patients that facial aging involves volume loss which means the loss of bone, muscle and fat. So fillers and other injectables do have a role in helping the loss of facial volume.

I would not recommend Restylane at this time. I think it would not give you the type of improvement that you are looking for, but rather find a surgeon that you are comfortable with and a facility in which you feel comfortable having your surgical procedure done.  I hope that was helpful, and thank you for your question.

Amiya Prasad, MD
New York Oculoplastic Surgeon
4.4 out of 5 stars 80 reviews

Lower Eyelid Blepharoplasty vs Fillers

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You have a combination of fat bags and hollowness at the orbital rim. I would recommend that the fat causing the bulging be repositioned to fill the grooves at the bottom of the lids. This can be done with an incision in the back of the eyelid so there is no visible scar and will provide a more permanent solution.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

Multiple options for cosmetic lower eyelid area improvement

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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 is slowly removed over time. Facial fillers (Restylane, Belotero) treatment is performed in the office vial local anesthesia. Results are immediate and last several months / 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.


Lastly, some plastic surgeons will treat all aspects of facial aging via combination treatment: skin surface, volume enhancement, and surgical lifting. Only after a comprehensive evaluation can a specialist help determine appropriate options for you. Best of luck.

Dr. Chaboki

Houtan Chaboki, MD
Washington DC Facial Plastic Surgeon
4.9 out of 5 stars 89 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.