Which is my Best Option Fillers or Lower Bleph? (photo)

I am 27 and have always suffered from puffy eyes since highschool. Makeup helps but does not heal! I went for s consultation and it was about 8 minutes so I did not feel comfortable enough to do it the cost was about $2800. He suggested a transconjunc... I just want to know what direction I should be going in. Please help I would like to get this done asap.

Doctor Answers 15

Lower bleph will remove fat pads causing puffiness.

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Fillers will not remove the puffiness and fat in the lower lids. A transconjunctival blepharoplasty involves an incision completely hidden on the inside of the eyelids to remove the herniated fat pads in the lower lids. This takes approximately a half an hour under a general anesthesia. Consultations with the physician take 30 minutes and an additional 30 minutes is spent with the office staff to completely educate patients and to answer all their questions about eyelid surgery. The cost of upper and lower eyelid surgery is listed on our web site.

Treatments for puffy eyes and pigmentation, and the importance of communication with your doctor

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Based on your photos, I can assess that there is puffiness under your eyes. Since you're young, your condition would do well with a transconjunctival blepharoplasty. However, there are some related procedures that can be considered when you’re having a procedure like this.

In my practice, we have a lot of patients who have pigmented skin, for example people from, Inida, Arab countries or African-Americans. To make the eyes look good, you not only want to reduce the puffiness, but you also want to address the pigment and skin quality. We often combine transconjunctival blepharoplasty with platele- rich plasma which is derived from your blood. This helps stimulate collagen and it has growth factors that has a nice effect on both skin quality and pigmentation.

The fact that you had a very short consultation is something that I personally don’t like. In my practice, I spend a lot of time with my patients because I strongly believe in communication and education. If you have the goal of looking better, a few minutes is not enough to understand the risk, benefits and the options you have in order to improve the appearance of your lower eyelids. I would suggest that you insist in spending more time with your doctor. If you feel that this was a qualified doctor and you didn’t get the time needed, then you should be sure that he takes care of you and really puts necessary amount of time to connect with you. I feel as a patient, when I or a member of my family goes to a doctor, I want time and attention.

I suggest that you consider additional opinions since clearly what we’re dealing with is something called prolapsed fat and that should be addressed. You must feel that your surgeon is going to take the surgery in the way that you deserve because it's not a generic procedure and surgery is an art; you don’t just take out all the fat you can and go on to the next surgery. There’s sculpting involved and repositioning that’s done which makes it a very personal, customized procedure. I just feel that if it’s a short consultation, I wouldn’t want my surgery to be short as well. I would further suggest that you make sure that you get the time that you need. I hope that was helpful, and thank you for your question.

Dark Circles, Tear Troughs and Hollows Respond Well To A Combination of Belotero Balance & Radiesse

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Tear troughs, hollows, 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 the Belotero Balance to be an excellent way of treating tear troughs and hollows and lightening existing dark circles. However, only an experienced, board certified aesthetic dermatology or plastic surgeon injector should attempt to treat this area in this fashion.

Fat Transposition Blepharoplasty

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I would not waste your money on a temporary procedure.  In a situation like yours, with prominent fat protrusion and moderately deep tear troughs, I would usually recommend a fat transposition lower eyelid blepharoplasty.  In this operation an incision is made inside the eyelid, and the protruding fat is moved down to fill the tear trough.  Also, injections around the eyes can be more risky than surgery. Follow the link below for some photos:

Lower eyelid surgery/ filler

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From the posted photographs, it appears that you have " tear trough " deformity. A conservative approach would be to have HA filler injection and re assess after few month. You can always have some modification of eyelid syrgery if you were not satisfied with the fillers.

Which is my Best Option Fillers or Lower Bleph?

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Always best to seek MORE in person opinions. BUT not in only eight minutes!!! I might try a filler first to the tear trough depression. But a Transconj. approach with fat re positioning and removal is optimal. 

Blepharoplasty or Filler

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I would not recommend a filler for your issue.  I agree that a transconjunctival approach for fat removal is a good option based on your pictures.  Seek out several other opinions by BC PS.

Dr. ES

Lower lid issues

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I think that it is best to be seen in person  to be properly evaluated for your lower lids. Sometimes fat removal is recommended for fat herniation, and sometimes fillers are god to camouflage the area.

Treatment for lower lids

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I do not think you need a blepharoplasty at this point. You should consider fillers and not rush into surgery, which has its own consequences. Get another opinion and don't rush into anything. Take time to research and consider the alternatives.

Trans conj with fat reposition

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While the pictures do not tell the whole story I do think you have some fat there.  I agree in that the problem is the tight crease.  If you were my patient I would suggest going transconj - you have no skin to remove and don't need an external scar - and reposition the fat to soften the crease.  No removal just repositioning.  Good luck, Dr. Schuster in Boca Raton.

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.