Surgery or Filler? (photo)

Im 32 i have under eye bags and dark circles I dont know what treatment would be recommended for me I feel that I have expirienced some volume loss on my overall face I have an appointment with a plástic surgeon on the 25 but I wish to go with some info and diferent points of view dont know if this can be adressed with fillers or a lowr bleph would be a better option please help Thanks

Doctor Answers 10

Please don't get lower eyelid surgery.

Properly done lower eyelid fillers will be so much better for you.  You eyes are beautiful.  Improving them will be difficult with surgery.  It is also a distinct possibility that lower eyelid surgery will actually make you look much worse and repairing this type of damage is very difficult and never perfect.  Fillers should on be the hyaluronic acid filler Restylane.  Silicone oil injections are common in Mexico and these will also destroy your appearance.  Please be careful.

Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Surgery or filler for under eyes?

It's difficult to tell from your pictures, but it appears that you may have some protrusion of fat under your eyes causing some puffiness.  There is an area of depression under the bag, which causes the dark circle.  There are two main options in treating this problem.  Surgery can be done to remove some of the fat and improve the puffiness.  This normally will also help with the dark circle under the area.  The other option would be to use a filler, like Restylane, and inject it into the depressed area under the bag to improve it.  The Restylane treatment would be temporary, whereas the surgery would have a much longer lasting result.  

Michael I. Echavez, MD
San Francisco Facial Plastic Surgeon
4.5 out of 5 stars 18 reviews

Surgery or Filler?

Fillers is a great option before you consider having a lower eyelid surgery, Restylane applied to the tear troughs would smooth out the under eye bags and help lighten dark circles, I suggest you seek a reputable injector to ensure a natural result

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 492 reviews

Surgery vs. Restylane to Tear Troughs...

I would highly recommend a non surgical approach, like Restylane injections, for you before even considering getting something as permanent as surgery under your eyes.



Dr. Grant Stevens        Marina Plastic Surgery Associates    Marina del Rey, CA         The Institute


Grant Stevens, MD
Los Angeles Plastic Surgeon
4.7 out of 5 stars 145 reviews

Under eye treatment

Without first seeing you in person to assess and determine your specific needs, it's difficult to recommend filler versus surgery. It sounds like you're aware that there are options to help improve that area and hopefully you get your questions answered with your scheduled consult.

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 221 reviews

Under eye fillers


  • Given your age and anatomy, I would start with Restylane under the eyes
  • It can produce dramatic results with no surgery
  • I would wait for surgery until you are older and that is always an option down the road

Best regards,

Nima Shemirani

Nima Shemirani, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 74 reviews

Surgery or filler for under eye hollows

There are 3 choices for dealing with under eye hollows:

  1. Surgery
  2. Filler
  3. Accepting it

It used to be that the only option was surgery or accepting it, but we now have hyaluronic acid (HA) fillers, such as Restylane and Belotero to fill the hollows and the depressions below under eye bags to camouflage their appearance. Many surgeons are recognizing that fillers may be a better choice than surgery for many patients. The great thing about HA fillers is that in the hands of an experienced physician the results should be very natural looking. If needed, HA fillers can be dissolved away, returning the appearance to baseline; this is something that can't be said of a surgical procedure. A surgical option can always be undertaken after fillers if desired. Be sure to seek an experienced physician to do the injections; this is considered an advanced technique of injection and you want someone who knows what they're doing in this area.

Kimberly Finder, MD
San Antonio Dermatologic Surgeon
4.7 out of 5 stars 62 reviews

Dark circles on lower eyelids

The cause of dark circles lower eyelids in someone your age is mostly due to congestion of the vessels which causes 'leakage' of a small amount of red blood cells into the surrounding tissue.  The muscle around the eye is just below the surface of the skin and the muscle color can add to this 'bruise' effect.  All that being said, I would suggest the following before you get into fillers would be:  1.  Take low dose antihistamines at bedtime to decrease vascular congestion  2.  Extra pillow at bedtime.  3.  Get 8 hours of sleep a night(you cut into sleep time and I guarantee your eyelids will show it first!) 4. Use an eye cream specifically design to treat dark circles.  These often have caffeine, arnica, Retinols and Vitamin K which will decrease congestion, minimize blood leakage and help to thicken and rejuevenate the skin overlying the muscles.   Be careful with 'fillers' in Mexico if you go there. 
Lots of horror stories from down there!

Steven Swengel, MD
Los Gatos Dermatologic Surgeon
5.0 out of 5 stars 11 reviews

Fillers Work Well For Dark Circles, Hollows, Tear Troughs and Bags Under the Eyes

Tear troughs, hollows, slight bags, and dark circles are common problems of the lower lids. It has become standard practice to treat this region with lighter weight fillers, like Juvederm or Restylane, to lift, straighten, and contour this region.

Occasionally, if fillers are inadvertently placed too superficially, a bluish discoloration related to light scattering (a phenomenon known as the Tyndall effect) can occur, which can actually make the dark circles more prominent. Belotero, a new hyaluronic acid product, has been manufactured to avoid this. However, I have found that the addition of a tiny amount of Radiesse, a whitish-colored filler, to Juvederm UltraXC, to be an excellent way of treating tear troughs and hollows and lightening existing dark circles. Only an experienced, board certified aesthetic dermatology or plastic surgeon injector should attempt to treat this area in this fashion.

When there is loss of some of the supporting fat pad in the upper inner cheek region (near the root of the nose), this, too, can contribute to the above problems. A small amount of volumizing filler, such as Juvederm UltraPlus XC, added to the this region further improves the overall appearance by rounding the curves of the inner cheek and also acts as a buttress to the under eye unit.

Nelson Lee Novick, MD
New York Dermatologic Surgeon
4.9 out of 5 stars 29 reviews

Try a topical cream first

Based on the photos, I would suggest an eye cream containing, retinol, green tea, and perhaps Vitamin K. There are multiple sources for these. I suggest a six months' trial. The cost is minimal.

Alexander Lewis, MD
Walnut Creek Dermatologic Surgeon

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.