Should I get a lower blepharoplasty or would filler help? (Photo)

Hi,Every case is very unique. In your case it seems the biggest issues are hollowing and negative vector. The bone of the under eye is further back compared to the eyeball.Overall the answer is that you would likely do best with filler or fat grafting to add volume to the area of hollowing. If surgery is considered, it would not be a traditional blepharoplasty where fat is simply removed or transposed. The lower eyelid needs to be supported. This has to be done precisely to avoid tightening it under the eyelid and creating even more of an issue. In all cases, you're anatomy requires extra precautions as it more challenging. Make sure you find a highly reputable oculoplastic surgeon. Good luck!

The kind of under-eye problem seen in the photos provided is a rather routine cosmetic problem treated practically every day in my cosmetic dermatology practice. Infraorbital tear troughs, dark circles and hollows are in fact some of the most common and troubling problems. Fortunately, there are now many different HA fillers that can be used to treat this. For one thing, there appears here to be quite a bit of cheek volume deficit, and since the upper cheeks constitute a major support for the infraorbital region, the use of a robust HA volumizing filler for the cheeks can give rise to an immediate, on-the-spot improvement not only in the cheeks themselves (to contour a more feminine, heart-shaped, oval face) but in the under-eyes. If still necessary, for further improvement, there are HA fillers designated specifically for under-eye use. From what can be seen in photos, there is little need for any aggressive, invasive, expensive surgery (that runs the risks for infection, scarring and prolonged downtime). You would be wise to consult with an experienced, board certified cosmetic dermatologist filler expert. Treatment typically takes about fifteen minutes to perform and the results typically engender an immediate "Wow!" reaction. Hope this helps and best of luck.

You have a number of issues that make it much more challenging for you to have a successful blepharoplasty result with a standard blepharoplasty. Your upper eyelids show latent ptosis with central levator disinsertion, high crease, and compensatory eyebrow elevation. Standard blepharoplasty will just remove your upper eyelid fold, which will skeletonize your appearance and make you look older. What you need is internal repair of the disinserting levator aponeurosis, crease lowering and anchor blepharoplasty to preserve the upper eyelid fold and reduce the amount to upper eyelid platform show. The lower eyelid are also complex due to the size of the eyes. Even without lower eyelid surgery, you have inferior scleral show. You have a small amount of herniated orbital fat. I think you could do very well with a carefully done filler treatment in the upper eye hollows. Please understand this is a fussy service. It will be challenging for you to find this service where ever you live. I have many patients who actually fly in for this type of service. Treatment lasts about 9 to 12 months and then it needs to be refreshed with a top off service. Surgery can be done but understand the risks involve.