Debating under eye filler or lower blepharoplasty to help with hollowness (Photos)

Question

I'm debating under eye filler or lower blepharoplasty to help with the hollowness underneath my eyes and would love any recommendations on what to do.

Jason Emer, MD · Answer

The eye area needs significant combinations to get improvement. Lasers like erbium, co2, halo, profractional/contour, or Fraxel can all be used to build collagen long term. Plasma pen is a newer less invasive option but will take many treatments and require proper skincare. Plasma Pen is focused electrical plasma energy to tighten skin, producing small columns of energy just above the skin, allowing the skin to tighten to help improve wrinkles. This area will have 3-5 days of small “dots” that will then scab and peel, then the skin will tighter and brighter after. Numerous treatments are needed over lasers where only one or two give a bigger result, but more downtime. After plasma pen you NEED peels 2 weeks like later Cosmelan, enlighten or aerify, see emeragecosmetics (link). At home derma rolling should be started weekly even after plasma pen or lasers to further increase collagen, see emeragecosmetics AERIFY x anteagemd stem cell ampules. To properly heal you need light Stim red LED, EmerageSkin refit face, refit eye; AnteageMD serum, silagen silicone gel, jan Marini bioshield, EmerageSkin enzymatic polish, and EmerageSkin hyla b and AOX, and Sente dermal repair. Otherwise there is EXTREME risk of pigmentation issues and “dots” in the treatment area. at home peels like cosmelan, enlighten and aerify along with dermarolling (AERIFY emerageskin roller with Anteage MD ampules) should be started now regardless for antiaging, sun damage, and wrinkle prevention. There are many things you can do to treat under eye hollows and dark circles. A surgical option to remove skin and/or fat will such as eyelid blepharoplasty with or without fat pad repositioning (if doing lower eyelid surgery) will be the best long term. There are many things you can do to treat under eye hollows and dark circles without surgery. Non invasive less downtime options such as fillers, lasers, microneedling/PRP, cosmelan peels, and microneedling RF like Fractora, PiXel8 or morpheus can all help give some improvement. Accutite can often be used or stronger lasers like erbium or co2 spot treatment can tighten the skin and give very quick improvement in wrinkles and texture. I suggest you get a formal consultation to see what is best for you and your goals. Best, Dr. Emer.

Michelle Zweifler, MD · Answer

For lower eyelid hollowness, one can start with hyaluronic acid fillers.  Usually, I first place some cheek filler for support then tear trough filler if residual depress exists.  Patients need to avoid aspirin/Advil/blood thinner products prior.  Fillers are not permanent, yet they seem to last longer in the tear trough than other areas of animation.
Lower blepharoplasty is performed with anesthesia and is a more permanent treatment option.
Both have risks and benefits that are discussed at consultation.

Zoran Potparic, MD · Answer

Based on these very limited photos correction of the eyelid problem in your case should involve improvement of tear trough deformity without skin removal with transconjunctival lower blepharoplasty.. Considering your young age, very likely that this early presentation is due to small cheeks (malar hypoplasia). Augmentation of cheeks and cheek eyelid junction with a combination of micro and nano fat grafts would be my suggestion. Good luck.

Nelson Lee Novick, MD · Answer

Let's see if we can make the decision so much easier. The photos provided suggest volume deficit in the cheeks. If this is indeed so, then the use of a robust HA volumizing filler for revolumizing and recontouring the cheeks can create a more feminine, heart-shaped oval face at the same time helping to treat the under-eye hollows (since the upper portion of the cheeks in the midface are a major support for the under-eyes). You will likely be so surprised and delighted that just a ten or fifteen minute treatment session in the hands of an experienced, board certified cosmetic dermatologist filler expert can yield immediate, on-the-spot, results that typically evoke a "Wow!" reaction. The additional good news is that this quick and simple procedure, as opposed to invasive surgery, is relatively inexpensive, involves no cutting nor stitches, and engenders little to no significant downtime. Admittedly, this may sound too good to be true. However, I literally have the words "Wow" painted on my mirror because that is the overwhelming response to this kind of treatment that I tell my patients in advance that they can expect a few minutes later and emphasize to them that any doctor would have to be nuts to put this in his/her mirror and make this kind of claim if he/she were not sure that a few minutes later that the patient would respond that way. Hope this helps and best of luck.

Darryl J. Blinski, MD · Answer

Based on your nicely posted photos, you could start with HA filler injections to tear trough deformity to see the results though temporary needing treatments 2 to 3 times a year. Fee ranges from $600-$1200. Or bilateral lower lid trans conjunctiva blepharoplasty for fat removal and fat repositioning fee under general anesthesia $4000. Final option is a combination of HA filler for tear troughs and trans conjunctiva blepharoplasty. Fee $8000-$10,000. Best virtual consult with.

Mats Hagstrom, MD (license on probation) · Answer

The lower eyelid midface transition zone is complex and simply making quality assessment is not easier straightforward.
This is best done with an in person consultation not by posting a few pictures online.
You’ll probably find the different providers have very different views on how to approach this.
This is going to be especially true for those who favor one treatment over the other.
In reality you need both.
 in a youthful, ideal face the contour of the lower eyelid should be snug and tight, followed by immediate fullness just below that area in the beginning of the midface.
With facial aging we sometimes see the reverse.
The lower eyelid will start bulging from weakness in the Peri-orbital septum. At the same time the area just below that loses volume, creating a tear trough. 
In some individuals, the bulging of the lower eyelids is primary, and then other is the loss of volume is primary.
Based on pictures, you’ve included your probably 50-50 or leaning slightly towards the lower eyelid, fat pads being slightly primary.
The area can change with movement of the eye and the eyelid so an assessment is usually best done dynamically during an examination.
If using pictures, then typically supply full face, proper pictures, taken a correct angles, including oblique, frontal, and profile pictures. Any anatomic area needs to be assessed in context to surrounding areas.
For that reason it’s generally always better to have full face pictures.
This area is complex not only in regards to making quality assessment, but also in regards to treatments.
Expect different providers to have different opinions and expect a wide range of competency from providers offering treatments and solutions.
Best,
Mats Hagstrom, MD

Debating under eye filler or lower blepharoplasty to help with hollowness (Photos)

Answers (6)

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