Blepharoplasty or filler for hollow under eye? (photos)

Question

My skin is very thin and transparent in that area and the circle/hollow is sometimes worse on one side and somedays look alright (rare)...hoping for something more perment then filler. would blepharoplasty sagg over time like under eye bags? Would it benefit to surgically tighten the under eye area if thats possible?

Mehryar (Ray) Taban, MD, FACS · Answer

Transconjunctival lower blepharoplasty with fat/bags repositioning is a good option for you. The existing eye bags/fat is repositioned to fill the hollow area under eyes with predictable, lasting results. See following link. Filler is another option but less effective and short-term.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation.  With that
being said, based on your photographs, the best shape and contour could be
achieved with either lower eyelid blepharoplasty or filler placement or fat grafting.   Make sure you specifically look
at before and after pictures of real patients who have had this surgery
performed by your surgeon and evaluate their results.   The most
important aspect is to find a surgeon you are comfortable with. I recommend
that you seek consultation with a qualified board-certified plastic surgeon who
can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Jason Emer, MD · Answer

A combination approach will give the most improvement. Fillers, lasers, and microneedling/PRP can improve under the eyes. My patients try to get non surgical treatments to avoid surgery. We use PRP and stem cells there often. I suggest consulting with an expert to develop a treatment plan best suited for your short and long term goals. Best, Dr. Emer

Toby Mayer, MD · Answer

Treatment of lower eye hollows and under developed cheeks? The best treatment for your problem iwould be small cheek implants for your under developed cheeks as well as lower blepharoplasty with fat repositioning. This can all be done through one incision below your eyelashes.  In my opinion fillers will just put off your problem to the future. See a very experienced surgeon who produces natural results.

Amir Nakhdjevani, MBBS, MRCS, FRCS(Plast) · Answer

Thank you for your question and pictures.  Lower Eyelid Surgery would be beneficial, from your pictures as there are small fat pads under the eyes which need to be removed, not volume added by filler.  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 or sedation if you would prefer.  Please find a reputable and qualified surgeon who can assess you properly to give you a realistic idea of what outcome you can achieve.  All The Best

Kian J. Samimi, MD, FACS · Answer

In our practice, we do inject filler in the under eye area quite often.  We often use Belotero or the newer Juvederm product, Volbella. These are great options for patients that have hollowness in this area and to correct a slight amount of under eye bags.  While photos can be deceiving, I would not recommend filler in this area for you.  I think you would benefit from a lower blepharoplasty. This way the enlarged fat pad can be treated instead of camouflaged.  Also, at the same time, any additional skin can be removed.  This would tighten the skin under the eyes and give a more smooth and rested appearance. Thank you for submitting your question!

Sean Freeman, MD · Answer

Polariyce, I would recommend a "SOOF lift blepharoplasty", it is the best procedure for the lower lid in my opinion. Seek the help of a plastic surgeon that specializes in "only faces" and has experience with this approach. See the video and good luck!

Robert Singer, MD · Answer

Most expert experienced artistic plastic surgeons have a variety of
procedures, both non-surgical and surgical, at their disposal to produce
excellent cosmetic results in the appropriately selected patient: neurotoxins
(Botox or Dysport), temporary fillers like Restylane, long lasting
micro-fat grafts, blepharoplasties, and combinations of procedures. There is no
one best procedure. Each has benefits and drawbacks and depends on desired
outcome and individual anatomy.
In a patient your age, a temporary hyaluronic filler like Restylane would be a reasonable place to start.
Following the advice of anyone who would presume to tell you what to do without
seeing photos and without taking a full medical history, examining you, feeling
and assessing your tissue tone, discussing your desired outcome and fully
informing you about the pros and cons of each option would not be in your best
interest. Find a plastic surgeon that you are comfortable with and one that you
trust and listen to his or her advice. The surgeon should be certified by the
American Board of Plastic Surgery and ideally a member of the American Society
for Aesthetic Plastic Surgery (ASAPS). You should discuss your concerns with
that surgeon in person.
Robert Singer, MD FACS

William Portuese, MD · Answer

A very conservative trans-conjunctival  fat removal that can accomplish removal of the bags or re-positioning it. A small cheek implant may also be helpful to augment the cheek as well.

Louis W. Apostolakis, MD · Answer

Hello,You have a classic negative vector lower eyelid.  This means the bone is not forward enough to give you the nice outward curve of the upper cheek area and that the fat that in the eye socket then hangs out over the edge and gives you bags.  The solution is as you suspect, not to remove the fat, but rather to support and fill the area under the fat.  In my hands, I would suggest a tear-trough implant which directly fills that area and gives you the "bony" support needed.  This is a permanent way to correct the problem whichis stable over time and at any body weight.  It is also reversible if for any reason you should choose to do so.  I would also caution you against removal of skin in the lower eyelid. Regards,Dr. /A

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