By your photos, I think you are a candidate for either filler or blepharoplasty, but you will most likely get a much better result with the surgery since you do have a rather significant amount of lower lid fullness. I personally do most lower eyelid surgery right in the office using local anesthetic. If you have very little excess skin, you may benefit from a transconjunctival approach. The recovery is faster and there is no visible scar. See someone that performs blepharoplasties on a regular basis (at least several a week).
Andrew Campbell, M.D.Facial Plastic SpecialistQuintessa Aesthetic Centers
In your photo, it appears that you are developing some puffiness of the fat pads and the tear troughs are visible. Filler such as Juvederm Voluma XC is a good option if you are not quite ready for surgical intervention. Voluma is placed between the soft tissues over the zygoma, and can provide a little "lift" of the cheeks which helps the tear trough area. My patients have been very happy with Voluma. (Also, I have personally had this done - 2 syringes of Voluma - and it helped tremendously!) Surgical options are available and include: 1) transconjunctival approach with repositioning or removal of orbital fat pads, 2) transcutaneous approach with repositioning or removal of fat pads. There are differing schools of thought on the approach, so you will hear different opinions - not a right or wrong issue, just different ways of achieving cosmetic goals for patients. One other option is a combination of filler and a pass of CO2 laser resurfacing to gently tighten the skin in front of the fat pads - another very pleasing treatment for the patient without the risk of surgery which is more invasive. Best wishes with your decisions!
Based on your photos, it appears that you could benefit
from either dermal fillers or blepharoplasty surgery. With that being said,
scheduling an in-person consultation with a highly accredited, board certified
plastic surgeon is needed to determine whether you would be a good candidate
for either procedure, especially if it involves surgery.
When it comes to dermal fillers for the lower eyelid,
they can restore a loss of volume, which may have contributed to the overall
puffiness, or sagging of the skin around the eyes. Additionally, the descent of
cheek fat can further emphasize eyelid depression, which is why fillers can be
a viable option.
While dermal fillers continue to be an effective
treatment for restoring volume to the skin, they will only last upwards of one
year, which means they will need to be repeated in order to maintain your
desired look. Though both options are acceptable, blepharoplasty to remove
excess fat in the lower lid will provide more permanent results.
Lower eyelid surgery candidate
From the one limited photograph, it appears that there is herniated fat pads in the lower lids which are significant. A trans-conjunctival approach lower lid blepharoplasty can accomplish removal of the fat pads with the incisions placed on the inside of the eyelid. No sutures are required. Anticipate approximately 10 days of visible bruising and swelling after the procedure. For more information and many examples, please see the link and the video below
Am I a candidate for under eye filler or a lower lid blepharoplasty?
Fillers often can produce a
nice temporary cosmetic improvement in some patients, but not all. They
certainly do not achieve what a well performed blepharoplasty will do.
Fillers can help improve
the cosmetic appearance but you will get only a temporary and limited
improvement with them. A better and long standing correction would be achieved
with a blepharoplasty of the lower lids: Conservatively contouring the bulging fat pads, which are
generally inherited, unrelated to weight, and tend to protrude more with time,
and smoothing the tear troughs with micro-fat grafts or fat repositioning.
Keep in mind that following
advice from a surgeon on this or any other website who proposes to tell you
what to do based on two dimensional photos without examining you, physically
feeling your tissue, assessing your desired outcome, taking a full medical
history and discussing the pros and cons of each operative procedure would not
be in your best surgery. I would suggest that you find a surgeon certified by
the American Board of American Plastic Surgery and one who is ideally a member
of The American Society for Aesthetic Plastic Surgery (ASAPS) that you trust
and are comfortable with. You should discuss your concerns with that surgeon in
Robert Singer, M.D., FACS
You already have a big bag in your eyelid. Why do you want to fill it even more with filler in it, or around it. Fillers are never good option for puffy eyelids. You need eyelid surgery.
Am I a candidate for under eye filler or a lower lid blepharoplasty
although both options can be done and you would look better, I think that with the minimal degree of excess skin I can see, albeit slightly limited in this picture because of the focus, in my opinion I think I would use fillers until the skin becomes more loose.
Lower eyelid bags plus tear troughs
Your photo suggests you are a candidate for either filler or blepharoplasty. However, if the tear trough is deep, then you may also benefit from a trans-blepharoplasty midface lift. With a much of a bulge of fat as you have, you may also benefit from lasering or chemical peels during surgery to help prevent new lines from appearing after you heal. You should definitely consult with a facial plastic surgeon or oculoplastic surgeon to identify what your best choices are.
I very often will inject filler into the hollows of the lower lid however in looking at your photo I would likely suggest surgery over filler. There is significant bulging of the lower eyelid fat pads and also significant hollowing of the lower lid sulcus. I have found that repositioning fat from the orbit into the lower eyelid hollows creates the best result with the aging changes that you have. It is essential to understand that a thorough exam is important before coming to definitive treatment plan, especially when we are talking about surgical management. Seek a board certified surgeon with significant experience in the type of procedure that is recommended.
Am I a candidate for under eye filler or a lower lid blepharoplasty?
Thank you for your important question and photographs. Adding filler is a temporary camouflage to some degree of puffiness but is never a permanent cure. This may still be best for you at the present time but eventually I would suggest a transconjunctival lower blepharoplasty with transfer of fat through fat grafting to the tear trough area. This may provide a very aesthetic outcome but I also mention to patients that sometimes the addition of filler to the tear trough remains beneficial and may need to be repeated once or twice yearly. The best advice is to have a face-to-face consultation with a board-certified surgeon. Best wishes and good luck.
Jon A Perlman M.D., FACS
Diplomate, American Board of Plastic Surgery
Member, American Society for Aesthetic Plastic Surgery (ASAPS)
Beverly Hills, California