My eyes look tired - What are my options? Under eye blepharoplasty vs filler (photos)

Question

Ive started to notice my eyes look more tired and am not sure what I should address. I definitely know the hollowness under my eyes are contributing but dont know if the upper brow is also causing a problem. Im considering filler to hold off on surgery for a couple more years but dont know if theres any benefit to delaying surgery. Thanks!

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.

Jonathan Kulbersh, MD · Answer

Thank you for your question and for providing photos. Facial fillers can be used to soften the hollows below the eyes and allow light to be reflected on the cheekbones, creating a brighter and more youthful appearance. The results from facial fillers generally last for 9-15 months. 
As you mentioned, lower blepharoplasty is another option that can rejuvenate the appearance of the skin around the eye area. This minimally invasive procedure can help the eyes appear more open and awake, with results lasting up to 10 years or longer. I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon who can assess your concerns and help you achieve your aesthetic goals.

Sam Speron, MD, FACS · Answer

This is a common question.  Horizontal eyelid wrinkles and sogginess can be corrected with blepharoplasty or cosmetic eyelid surgery. It is one of the first cosmetic surgeries people usually get. While the average age might be 30 to 50's, some patients get this done in their 20s. It really depends on your unique anatomy as well as what exactly is bothering you.

Botox injections as well as laser treatments can also be a tremendous benefit if you are not interested in surgery. Of course, there are also many combinations.

A mini facelift or midface lift is another great option for many people to correct malar bags and other signs of aging around the eyelids. The recovery & downtime is very minimal. There are usually no drains, most people can go out the same day, you can shower the next day, there are no scars behind the ears and you can wear your hair up anytime and most patients take no pain medicine. There are never any guarantees of course with any procedure whether it is surgical or nonsurgical in nature.

I would recommend that you see a board-certified plastic surgeon in your area that is a member of both ASPS & ASAPS and performs a lot of eyelid lifts but also offers all the nonsurgical options such as injectables and laser treatments. Go over your concerns with them and make sure above all, you walk out of there with several options and an idea of the pros and cons to each of them as well as realistic expectations.

Nelson Lee Novick, MD · Answer

The upper cheek acts as a support for the under eye region and when there is volume deficit or loss due to the aging process under eye tear troughs and hollows, as seen in the photos, are a natural consequence. Restoring the volume to the upper cheek area with an appropriate HA filler properly injected can address these issues and nonsurgically rejuvenate the under eye area. The results often can last for a couple or more years. I even had a patient whose results lasted seven years after filler treatment. And, there is a reason for delaying surgery. First, surgery does not guarantee permanent improvement, since continuing age-related volume loss in the region can once again result in the same issues perhaps five years down the road. On the other hand, fillers can be used whenever necessary and can tailored to the specific needs of the moment. A couple of additional factors; surgery tends to be expensive and engenders real post-surgery downtime. Fillers tend to yield immediate results and engender little to no significant downtime. Make sure to consult with an experienced, board certified cosmetic dermatologist before jumping to surgery. Hope this helps.

David Plank, MD · Answer

Filler is a good temporary option for lower eyelids for annual treatment. Filler does cause some scarring in the area after reabsorption and leaving the lower eyelid skin stretched requiring more filler the next treatment. Due to this, I have transitioned to lower eyelid fat grafting for a permanent result. Fat grafting provides multiple benefits including improved blood flow for a youthful look.

Bilgen Katipoglu Erenoglu, MD · Answer

Hi, summerbree! Thank you for your questions and photos.
The tiredness of your eyes are due to 3 reasons. One is the low location of your brows. (Not too much but some lift will benefit) Second is the fullness of your eyelids. An eyelift (blepharoplasty will help you get rid of the heaviness of your eyelids. Third is the descend of your midface. This causes volume loss on the cheeks and also cause hollowness under the eyes. 
So my recommendation for your face is an endoscopic midface lifting with/without fat injection, and eye-lifting surgery. These will provide a fresh, young and attractive appearance on your looks.

Robert T. Buchanan, MD (retired) · Answer

Surgery, blepharoplasty, is an option when you have excess skin. Some physicians do transconjunctival "blepharoplasties" to move the fat over the orbital rim. Unfortunately, I have not found this to work well. With what you have, the best treatment is use of a filler like Juvederm Voluma below the orbital ligament on the bone. However, be very careful, since the majority of injectors use a light filler superficially above the ligament which has a very high complication rate.

My eyes look tired - What are my options? Under eye blepharoplasty vs filler (photos)

Answers (7)

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