Restylane Removed Before Pinch Blepharoplasty? (photo)

I am a 42 year old female that had restylane injected in my tear trough 2 months ago. The results were only so so. I still have dark circles most likely from genetics and possible skin staining. I still have excess skin that I need to address. I am considering a pinch blepharoplasty. Should I have the restylane removed before the bleph to get the best results from surgery?

Doctor Answers 9

I recommend procedures to keep your lower eyelids supported and to add volume in the eyelid-cheek area

In the book I wrote called “The Fine Art of Looking Younger”, I teach my patients on a daily basis that facial aging is volume loss and descent. At your age, although there are some changes in the shifting or stretching of the tissue which happens when aging, I think you’re dealing more with volume loss. It's important to know that volume loss at several levels has no single solution.

Loss of volume or hollowing in the tear trough area happens because the tissue and fat in the eyelid-cheek area tends to diminish until it gets deeper. Placing Restylane in that area is a good way to help soften it. When it comes to a relative excess of skin, removing this excess skin may pull your eyelid down.

In my opinion, a good strategy for you is a skin pinch removal with blepharoplasty. I would also do canthal tendon reinforcement which means reinforcing the tendon that holds the eyelid in position in order to prevent the eyelid from pulling down. There are many patients who came to our practice who have had skin removed in the lower eyelid by another surgeon, and it caused their eyelid to either evert, pull down or both.  I hope that was helpful to you, and thank you for your question.

New York Oculoplastic Surgeon
4.3 out of 5 stars 72 reviews

Periorbital Rejuvenation

I usually have patients wait until the Restylane has resorbed prior to proceeding with this surgery so that optimal results can be obtained.  It's only a few months.


Asif Pirani, MD, FRCS(C)
Toronto Plastic Surgeon
5.0 out of 5 stars 35 reviews

Restylane Removed before Blepharoplasty


One of the primary goals of lower eyelid blepharoplasty is to create a smooth contour to the lower eyelid and cheek junction.  In order to create this some fat may be removed, repositioned or added.  In order to precisely place fat you want a stable non-changing platform.  The restyane will continue to absorb and change over time.  If the restylane is not removed you could potentially get an under correction if the future resorption isn’t exactly in anticipated.  Therefore I prefer to remove  restylane injections with hyaluronidase if they were performed close to the time of surgery.

Jill Hessler, MD
Palo Alto Facial Plastic Surgeon
5.0 out of 5 stars 26 reviews

Restylane Removed Before Pinch Blepharoplasty? (photo)

Another opinion for you to think about! I recommend pinch lateral bleph. + fat grafts to tear trough + TCA peeling. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 174 reviews

Lower eyelid surgery

   The primary goal of lower blepharoplasty us to remove  the 3 fatty deposits in the lower lids creating the puffiness look.  The secondary and minor goal of lower lids is to remove a small pinch of skin when there is excess present. This incision is closed with Histocryl tissue glue so there's no sutures. There's probably no reason to remove the filler injected into the tear troughs before undergoing a blepharoplasty.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 145 reviews

Pinch blepharoplasty and filler

It might be a good idea to allow the filler to dissolve or to dissolve it with hyaluronidase before undergoing surgery.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Restylane Removed Before Pinch Blepharoplasty?

It is hard to tell from your photos. You do appear to have a small lower eyelid bag though the notes on the photo state that is just a dark circle. However, you do not appear to have much extra skin in your lower eyelid. Either way, if you were to undergo a lower blepharoplasty, I would typically wait until the filler has dissolved or remove it with hyaluronidase prior to surgery. With regard to whether you should proceed with surgery, I would recommend a consultation to determine what, if any, option would be best as it is difficult to assess with the provided photos. I hope this information is helpful.

Stephen Weber MD, FACS

Weber Facial Plastic Surgery

Stephen Weber, MD, FACS
Denver Facial Plastic Surgeon
4.9 out of 5 stars 129 reviews

I have to agree with Dr. Hughes.

I don't think a "pinch" bleph is such a good idea based on these photos.  I question if you had an adequate filler service.  A chemical peel of the lower eyelid is a very good suggestion to create lower eyelid firming.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Restylane Removed Before Pinch Blepharoplasty?

         I do not see much loose skin. I do not think that you need a skin pinch blepharoplasty.  I would probably do a TCA peel for you, if anything at all.  Kenneth Hughes, MD Los Angeles, CA

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 496 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.