Can a lower blepharoplasty help with hollow under eyes and dark circles? Make it worse? No bags or puffiness here!

Question

have a very thin face and hollow under eyes, dark circles rather than bags. My orbital bone is prominent and I am so unhappy with this. I have had fillers and of course that is temporary. I explored fat grafting and found unhappy patients who had this and Dr's who had to correct it. My plastic surgeon will not inject fat under the eye area and instead recommends a lower blepharoplasty. Can this help my hollows and dark circles? Could it make it worse?

Mehryar (Ray) Taban, MD, FACS · Answer

The answer depends on your specific anatomy and it depends on how the lower blepharoplasty is done.  Ideally, if there enough fat present, it is best to reposition the bags/fat to fill the hollow area (dark circles). That not only insures the bags are gone, it also fills the hollow area and insures you won't get hollow later. If there is not enough bags/fat present, then it might be best to do filler injection instead. See link below.

Brett S. Kotlus, MD, MS, FACS · Answer

If fillers were helpful in diminishing your under-eye shadows, it's possible that fat grafting could do the same. Fat grafting can be less predictable than fillers but it also has the potential to be longer-lasting.  Blepharoplasty may also be an option if you have enough fat to redrape into the hollows.  You should consult with a surgeon that has substantial experience with cosmetic eyelid surgery and fat grafting/repositioning under the eyes.

John J. Martin, Jr., MD · Answer

You really need to post some pictures to get a good answer.  However, if you have hollow lids and prominent orbital rim,  a regular bleph is not going to help much.  By removing some skin, you do stretch out what is there, and this can sometimes make it appear lighter.  Fat transfers can be done, but in this area they are tricky, so see someone who does them routinely.  Your other option is to continue with the fillers.   Something like Restylane usually lasts at least a year.

Chris Thiagarajah, MD · Answer

Dark circles are caused by pooling of blood. A blepharoplasty will not help it unless there are pockets of fat casting a shadow. Talk to your doctor to get a better understanding.

Katrinka L. Heher, MD · Answer

I agree with you that fat grafting can lead to problems and thus I rarely recommend that approach.  Many people in you situation can benefit form a lower lid blepharoplasty combined with fillers and have great results.  Restylane can last a very long time in the lower lids so do not be discouraged by it's temporary effect. I would recommend seeing an oculoplastic specialist who deals with your problem on a regular basis. Best of luck

Michael Law, MD · Answer

It is very important to preserve (or restore) soft tissue volume in the lower lid. Please view my fat grafting gallery below.  When I review with eyelid surgery patients some photographs from their twenties, in most cases we find that years ago there was no visible demarcation between lid and cheek, but instead a smooth, gently convex curve extending downward from the lower lid margin.In patients who have developed deep 'tear troughs' at the junction of the lower lid and cheek, adjacent to the side of the nose, the meticulous grafting of fat harvested from the patient's abdomen, hips or thighs can build this area back up and nicely restore a more youthful contour. In some blepharoplasty patients this depression or 'hollow' extends horizontally across the entire junction of the lower lid and cheek, and this must be corrected to obtain the ideal postoperative result.

Vasdev Rai, MD · Answer

Each situation is different. In some situations lower blepheroplasty will help your condition.  You should discuss your concerns with your surgeon as you make this decision. It is not possible to give input without in person assessment.

Steven Wallach, MD · Answer

You would have to be seen in person to make sure you are a candidate. A lower blepharoplasty can help with herniated fat and loose skin. The depression along the lower lid can sometimes be released and softened.

Jeffrey Zwiren, MD · Answer

Just want to avoid nursing home eyes with over resection of orbital fat.  If there is no prominent fat of the lower eyelids and only a dark discoloration you will not benefit from surgery. Fat grafting of the mid cheek up to the orbital rim in a vertical fan pattern can be very useful.  Need an examination to determine if this is the proper treatment.  Do not inject fat directly into the lower lids will be uneven with this approach.   Try a product like Teamine that can mask the dark color.

Brooke R. Seckel, MD, FACS (retired) · Answer

I agree that fat injection is a bad idea.However a transconjunctival blepharoplasty with arcus marginalis release and a composite fat graft (whole piece of fat) can prevent the hollow look and correct dark circles under the eyes.For more information please read below:

Can a lower blepharoplasty help with hollow under eyes and dark circles? Make it worse? No bags or puffiness here!

Answers (11)

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