Lower Eye Lid Surgery or Fillers?

I am looking for a permanent solution to the bags under my eyes. I can't spend $5,000 but I do want to go with someone who is very well versed in this surgery and give great results as this is my face and once you are done you are done. I don't want to take chances. I have heard that sometimes the bags come back - I will cry...My issue is passed down from my dad and grandmother - but is only made worse if I cry or don't get enough sleep! Please help me someone!

Doctor Answers 13

Nonsurgical Rejuvenation of the Lower Lids

The most appropriate approach(es) for rejuvenating the lower lid region in any individual are best determined by an in-the-flesh consultation with a board certified aesthetic physician with extensive experience in treating this region.

In general terms, however, owing to the disproportionate attention paid to our eyes by observers, when the regions surrounding them look great, we look great, and when they look tired, swollen, baggy, crinkled, wrinkled and ringed by dark circles, we appear exhausted, worn out, frazzled, and older. With the passage of time, many of the changes that we see result from shrinkage shriveling, and a downward descent of a once robust, heart-shaped fat pad that sat immediately under the lower lids and extended out toward the temples, inward toward the root of the nose, and downward about half-way to the angles of the mouth. The loss of this volume and its displacement in the direction of the jaw elongates the lower lid to several times its narrow youthful width and leaves it somewhat sunken.

Likewise, the thin, delicate skin below the eye darkens in part due to the reflection of the darkish color of the underlying vessels that were once hidden by the presence of the fat pad. And, finally, like a balloon having lost its air after being fully inflated for a long while, the skin of the lower eyelid fails to snap back to its youthful smoothness, and instead remains crinkled and baggy.

In the past, lower lid Blepharoplasty was the only treatment for these problems. Today, many wishing to avoid the expense, discomfort and downtime can be treated with the injection of volumizing and filling agents to restore the volume to the lower lid regions and to treat hollows, dark circles, and tear troughs and recontour them, mask the bags, and diminish the darkish discoloration.

A variety of volumizing agents have been used for this purpose. They include Radiesse, Perlane and Juvederm Ultraplus. My personal favorites are Juvederm Ultraplus for providing overall smoothness and shape and Perlane when more of a lift is required. When necessary, I combine both agents to recontour and lift the cheek directly below lids to support them. For the very thin skin immediately below the lashes of the lower lid, to treat hollows, tear troughs, and dark circles, I prefer to combine a tiny amount of Radiesse (which has a whitish color for masking) and Belotero Balance. Since the bulk of the materials used are composed of hyaluronic acid, should the need arise, they can be dissolved quickly with microdroplets of an enzyme known as hyaluronidase.

It usually takes about five minutes to treat each lower lid, and the results are immediate, typically evoking a "Wow!" response from the patients when they look in the mirror.

While minimal bruising, tenderness, swelling and redness may occur following treatment in this delicate region, these are usually temporary and disappear spontaneously within one to seven days. Most people can return to work or social activities immediately or the following day and may use makeup if desired.

New York Dermatologic Surgeon
4.9 out of 5 stars 30 reviews

Lower Eye Lid vs. Fillers

A picture would help with this question. Under eye bags can be due to a genetic condition in which you develop intermittent swelling underneath the eye. This usually does not improve after traditional eyelid surgery. If the bags are due to some protrusion of fat from the orbit then this can be corrected with eyelid surgery. Nothing, however, is ever permanent. Consult with a board certified surgeon who has experience operating on the face to find out if you are a good candidate for surgery. If you are not a candidate for surgery, fillers can sometimes be a good option to mask or hide the bags.

Kristina Tansavatdi, MD
Los Angeles Facial Plastic Surgeon
5.0 out of 5 stars 33 reviews

Lower lid treatment

An exam is required to determine which procedures or treatments would benefit you the most. Regardless of what is done, the aging process continues, and as tissues re-relax over years, the bags can recur.

Patti A. Flint, MD
Scottsdale Plastic Surgeon
4.6 out of 5 stars 55 reviews

Lower Eye Lid Surgery or Fillers?

Treatment options will vary from individual to individual.  Lower eyelid surgery involves the removal of fat, excess skin and muscle.  If you have a pocket of fat beneath your lower eyelids but don't need to have any skin removed, a transconjunctival blepharoplasty can be performed.  In this procedure a tiny incision is made inside the lower eyelid and fat is removed with fine forceps. No skin is removed, and the incision is closed with dissolving sutures.  The results of this procedure will last for many years where as injectables are temporary.  Be sure to visit with a Board Certified surgeon who will advise you of your surgical options.  Although the cost is a factor in the decision making progress, the end result is most important.

Frank Lista, MD
Toronto Plastic Surgeon
4.5 out of 5 stars 111 reviews

Lower eyelid bags

Lower eyelid surgery to take care of bags is very effective. Fat is either removed, repositioned, or both, through an incision on the inside of the eyelid. If there is redundant skin, this can also be removed by way of an incision just below the eyelashes.  Fillers and laser can be helpful in people with mild bags. Consult with an oculoplastic surgeon about your options. When done in the office, the cost can be significantly less.

Matheson A. Harris, MD
Salt Lake City Oculoplastic Surgeon
5.0 out of 5 stars 7 reviews

Lower lid eye bags

Dear Hourglass 38.This is exactly when you want to consult with a Specialist board-certified Plastic Surgeon. There are times when fillers do the trick, there are times when laser does the trick, and there are indications for surgery. There is no point choosing one option because it costs less. If a reputable Plastic Surgeon suggests that surgery is the better option, then you are better off saving your money until you can afford the best option. Having said that, fillers or laser can give great results for that dark exhausted look under the eyes. Check it out with the right people before you make a decision. I wish you well in your endeavours.

Mark Edinburg, MBBCH, FRACS
Sydney Plastic Surgeon
4.8 out of 5 stars 27 reviews

Fillers or Surgery for Eyelid Puffiness

Fillers are only useful for patients with hollowing and mild puffiness of the lower eyelid. They are actually preferred to surgery in this circumstance, since surgery would be too aggressive in many of those patients. If you have more substantial puffiness, then fillers can not smooth out the contour. If you fill too much, the eyelid looks swollen. Other times, the filler can support and accentuate the puffiness, making it even worse.

There are no substitutions for surgery if you have moderate to severe lower eyelid puffiness. If the cost is prohibitive, then wait and save until it is affordable.

Best of luck

Richard W. Westreich, MD
Manhattan Facial Plastic Surgeon
4.9 out of 5 stars 52 reviews

Lower eyelid blepharoplasty surgery

 The primary goal of  lower eyelid surgery is to remove the  3 fatty deposits located in the lower lids. A conservative removal of these bags is performed through a trans-conjunctival approach( Inside the eyelid) under a brief general anesthesia. If there is excess skin present, a external lash line incision is made and a pinch technique excision of the excess skin is removed and closed with tissue glue. Expect 2 weeks of bruising and swelling after the procedure.  For examples please see the link below

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

Surgery or fillers?

There is a lot of additional information needed---age, medical condition, severity of the lower lid bags, etc.  Lower lid bleph, in a patient with good indications, should last for many, many years.  It is true that fillers are temporary but they do have their place in treatment options.  I would encourage you to see a board certified plastic surgeon for a consultation.  Remember that the fee includes anesthesia (a board certified anesthesiologist in my accredited facility) and the facility fee; when you divide it up, it is not a really expensive operation-although I know that it all comes from the same pocket for the patient!

Robert L. Kraft, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 42 reviews

Fillers or Surgery for Lower Eye Bags

First of all, without pictures or seeing you in person, it is impossible to give you specific advice.  However, if you are looking for a permanent changes, then fillers are not your answers.  Fillers are a temporary solution.  However, if you are a good candidate for fillers, they can be very effective.  However, fillers ADD volume.  So, they are good if you have hollowness under the eyes.  If you have "bags," then surgery may be your only option as the fat would need to be removed or repositioned and the extra skin possibly removed.  I would suggest being evaluated by a board certified plastic surgeon.


Good Luck. 

David Shafer, MD
New York Plastic Surgeon
4.9 out of 5 stars 77 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.