Restylane Under Eyes vs. Lower Eyelid Surgery

I am a male in my late 40's considering Restayne under the eyes to address the puffiness under my eyes before it gets too bad. I have an appointment scheduled with Dr. Brackup in PA but I am now considering cancelling after reading all the negative experiences on this site. Is it better to just have lower eye lid surgery and not risk the poor potential outcomes associated with Restalyne? Thanks in advance for responses.

Doctor Answers 12

Heavy bags under the eyes: Filler vs Surgery

As we continue to age, the fat in our lower lids will continue to become more prominent creating the appearance of "bags" under our eyes and causing a depression, hollow, or shaded area below them.  This can give the appearance of tired eyes despite getting adequate sleep.  

One option which is minimally invasive, is to inject Restylane, a facial filler just under this fat and efface this hollow between the eyelid fat and the cheek to give a smoother transition.  Of course, Restylane is a temporary fix and will last 6-9 months.  

Another option is to undergo a lower blepharoplasty, or eyelid lift.  Here the fat is slightly trimmed or moved into the hollowed/depressed area.  A small pinch of skin is also taken at the time of surgery.  These results are longer lasting (5-6 years).


Houston Facial Plastic Surgeon
4.8 out of 5 stars 63 reviews

It takes a lot of skill to determine if filler is the way to go for eyelid bags

The issue of treating under eye bags with filler or surgery is complicated.  Some people really have excess lower eyelid fat.  In those patients surgery is the way to go.  Other people just loose some fat in their cheeks, so the eyelid fat becomes more apparent.  In those situations, Restylane is a better treatment.  It takes a skilled cosmetic surgeon to decide which treatment is right for you, and then to perform the treatment well.

Dr Brackup is a very experienced and skilled expert on this topic.  I would speak to him about your concerns.

Marc Cohen, MD
Philadelphia Oculoplastic Surgeon
4.8 out of 5 stars 24 reviews

Lower Eyelid Puffiness Better Treated With Fat Removal Blepharoplasty Rather Than Injectable Fillers

Without photos it is impossible to say for sure what the best treatment is, but you did utter one word which is very revealing...puffiness. That is quite different than the term...hollowing. Puffiness indicates that there is lower orbital fat herniation as the cause. That is best treated by fat removal rather than trying to mask the problem by putting injectable fillers around it. By doing so you run the risk of making the whole lower eyelid look even more puffy. At your age, you may do well with a transconjunctival lower eyelid fat removal procedure done from inside the eyelid without having to remove any skin. 

Barry L. Eppley, MD, DMD
Indianapolis Plastic Surgeon
4.7 out of 5 stars 72 reviews

Filler versus blepharoplasty for lower lids

Hi Ambler,

Making recommendations on specific concerns without being able to evaluate you is difficult; however, it sounds like your concern is due to bags under the eyes.  This can be disguised with filler or with a blepharoplasty.  Of course, the downside with fillers is that they go away; whereas, with some blepharoplasty techniques, the result for many years or decades.  I would carefully consider both options before proceeding, but would lean toward blepharoplasty with fat transposition.

Good luck!

P. Daniel Ward, MD
Salt Lake City Facial Plastic Surgeon
5.0 out of 5 stars 41 reviews

Restylane versus lower lid blepharoplasty for eye bags

Restylane can be a great option for improving the appearance of the periocular area for some individuals.  Posting photographs would help determine if you are a good candidate for this versus lower lid blepharoplasty.  I would suggest getting a second opinion - since you are interested in improving the appearance of your eyelid area you may want to consider seeing an oculoplastic surgeon.

Keshini Parbhu, MD
Orlando Oculoplastic Surgeon
3.9 out of 5 stars 10 reviews

Fillers and Lower Eyelids

My patients have had great success with fillers. Upon examination an experienced well trained surgeon will be able to recommend the treatment options which would best address your individual concerns. If you are not confident with your choice of surgeon seek a second opinion.

Michael Sullivan, MD
Columbus Facial Plastic Surgeon
4.9 out of 5 stars 88 reviews

Fillers more often than lower bleph

The only person who must do lower bleph is one with bulgy fat bags.  Those with tear troughs can have Restylane to fill them is.  Restylane is safer than surgery.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 67 reviews

In most people, a well-performed Injectable Filler procedure is a better option than lower blepharoplasty.

I read your concern. You could get better information if you post a photo along with your concern.

In most people, lower eyelid fat should be preserved. Removal of lower eyelid fat "bags" may lead to a hollow, operated appearance and wrinkling of lower eyelid skin. The appearance of bags is likely due to the formation of lower eyelid grooves (tear troughs) from age-related loss of fat in the area where the lid bag meets your cheek. In my practice, filling the groove may lead to natural-looking rejuvenation without surgery. My personal preference is to use Silikon-1000, an off-label filler, for permanent results.

I've attached a photo of an older gentleman that was treated in this fashion.

I hope this is helpful for you.

Regards from NJ:

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 418 reviews

Restalyne or Juviderm can be used for fill out the eyelid crease.

The question is difficult to answer without seeing a photo. If you have excess skin and/or fat, then a blepharoplasty is needed. If you have hollowing, then fillers are best.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 34 reviews

Restylane vs Lower Lid surgery

Restylane or Juvederm can work very well for some lower lid bagginess (not all). Lower lid surgery can have poor results too. The key factors are what you are a good candidate for and the skill of the surgeon. Without photos I cannot make specific comments.

Peter T. Truong, MD
Fresno Oculoplastic Surgeon
4.9 out of 5 stars 38 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.