I have fat pockets under my eyes. What is the best treatment? Some doctor say surgical removal others say filler.

Without seeing photos or doing in an person examination there is no way to know what treatment options are best.  Please post photos.  Best of luck, Dr. Emer.

Fat bags of lower lids--filler or blepharoplasty is a common question. If you are young and the fat bulges over the bone=blepharoplasty with possible fat repositioning. If you are older and the bulging fat is behind the bone=fillers or blepharoplasty with fat repositioning. 

Some would benefit from fillers more and others would benefit from surgery more.  The answer depends on the person's specific anatomy and desires. If there is more hollowness than puffiness, then fillers are better option to fill the hollow lower eyelid area.  If there is more puffiness/bags, then lower blepharoplasty with fat repositioning maybe the better option, where the existing "bags" or fat is repositioned to fill the hollow area underneath it.

    This would be difficult to make a determination without an examination or pictures. Kenneth Hughes, MDLos Angeles, CA

WIthout a personal consultation it is impossible to tell you what your best option is.  For many, under eye Restylane is not just an alternative to surgery but it is a far better option that surgery with results that far exceed what could ever be accomplished with surgery.  For others, it is abundantly clear that they would be much better off with surgery.  For many people the choice is some where in between and it often comes down to preference.  For some they are uncomfortable with the idea of surgery and prefer an in office non surgical option that really makes a difference.  Of others, they don't want a solution that involves maintenance of a treatment effect.  For some, the issue is the lack of availability of expert filling service.The important point is that you generally have a choice here.  Also without a personal consultation where the surgeon physically examines you  which included feeling the lower eyelid circle to determine what makes up your circle, it is impossible for someone to intelligently recommend the service that will be right for you.

There are many different options to address under eye fat pockets. It would be helpful if you posted a picture so we can get a better idea of your concerns. You can use fillers to camouflage them  or you can surgically remove them. However, it is not possible to tell you what would be better without a seeing you in person. Consult an oculoplastic surgeon. Hope this was helpful!

Unfortunately, without examining you, there is no way to answer your question.  Both are good treatments, but the proper treatment would be dependent on your findings.  See an experienced eyelid surgeon for a personal recommendation.

Most expert experienced artistic plastic surgeons have a variety of procedures at their disposal to produce excellent cosmetic results in the appropriately selected patient with bulging herniated fat pads and accompanying areas of hollows of their lower eyelids: temporary fillers with hyaluronic acid fillers like Restylane which usually last 6 months to 1 year, micro-fat grafts of your own tissue - 30-50% lasts permanently, and blepharoplasties . There is no one best procedure that would be applicable for everyone. Each has benefits and potential drawbacks. The vast majority of board certified plastic surgeons with extensive experience in eyelid surgery and soft tissue fillers would warn against using a permanent synthetic filler because of the long term complications which can occur even years after injection and are difficult if not almost impossible to correct.The best option in any particular patient needs to be individualized based on desired outcome and personal anatomy. If the fat pad fullness is significant just adding a filler or fat grafts generally does not produce a satisfactory cosmetic improvement.Following the advice of anyone who would presume to tell you exactly 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 FACSLa Jolla, California

Thank you for your question. Pictures will be helpful in terms of giving more detailed or specific advise. In general, it depends on how bad your lower eyelid bags are. If minor, fillers will camaflouge it. But this only serves to mask the problem temporarily. If you need surgery, nothing replaces surgery. When the fatty tissue and or skin is removed from your lower eyelid, this fat also is the best filler for orbital rim and tear trough depressions. It is better than any man made type filler.

It is difficult to give you a proper answer without pictures.Generally speaking, fillers are temporary. Surgery tends to give longer lasting results. After careful evaluation, should you only have fat pockets with no excess skin, these can be dealt with through a hidden incision (Trans-conjunctival).