I have under eye puffiness. Based on my pictures, would you recommend fillers or a transconjuctival blepharoplasty? (Photo)

I am hoping to get long lasting results but also would like your thoughts on the most conservative approach in order to avoid hollowness. I am 27 years old.

Doctor Answers 18

Lower eyelid bags

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You are too young for surgery. In my opinion you will benefit from filler injections into the tear trough areas. You should seek a consultation with a plastic surgeon. Good luck!

Trans-conjunctival approach for lower eyelid blepharoplasty

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 A trans-conjunctival approach can address removal of the fatty deposits in the lower lids creating the puffy look. In our practice we do not recommend  fillers placed in the lower lids. For many examples, please see the link and video below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 157 reviews

Is surgery or fillers my best option for my puffy lower lids?

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Many factors determine the best treatment for lower eyelid bags. While both could be options for you, I would recommend filler if you were my patient.

Jeffrey M. Joseph, MD
Newport Beach Oculoplastic Surgeon
5.0 out of 5 stars 17 reviews


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Fillers will do the best for you. You do not need any surgery. Restylane or Voluma will be excellent choice. 

Lower lids

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gab.oro, I would recommend a "SOOF lift blepharoplasty". I have used this approach for over 20 years with excellent results and minimal risk. Search the Internet for a physician familiar with this approach. Seek an experienced surgeon who does only faces. Good luck!

M. Sean Freeman, MD
Charlotte Facial Plastic Surgeon
4.7 out of 5 stars 55 reviews

Puffy eyes

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You certainly look like a great candidate for a transconjunctival lower lid blepharoplasty. The areas of fullness appear to be fat as opposed to swelling, and you don't appear to have much excess lower lid skin. Going through the conjunctiva to remove the excess fat will create a smooth contour to your lower lids and the downtime is minimal. The results last a very long time, usually decades.

Andrew Campbell, M.D.
Facial Plastic Specialist
Quintessa Aesthetic Centers

Andrew Campbell, MD
Milwaukee Facial Plastic Surgeon
4.7 out of 5 stars 25 reviews

Lower lid bags

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When there is an excess of fat herniating in the lower eyelids, trans conjunctival lower blepharoplasty is usually the best option for treatment. That is not to say it is the only option, and filler can do very well when placed in this area by skilled hands, but it is really just more of a Band-Aid hiding the problem as opposed to fixing it.

To ensure you are receiving the highest level of care, seek out a modernly trained, new-school dermatologic surgeon, oculoplastic surgeon, facial plastic surgeon or plastic surgeon who is board certified and fellowship trained in one of these "core four" cosmetic specialties.

Cameron Chesnut
#realself500 Physician

Cameron Chesnut, MD, FAAD, FACMS
Spokane Dermatologic Surgeon
4.9 out of 5 stars 121 reviews

Possibly fillers

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Fillers can be delicately placed along the lower lid to soften the appearacne. If it is herniated fat, then give it might require conservative removal.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Do your own assessment.

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Put your finger on top of the lower eyelid bulge.  Press on it.  If it is firm or hard, this is your orbital rim not herniated orbital fat.  If it is orbital rim, transposing fat is not going to get the job done.  Fillers would be the preferred option here.  Even if the budge is herniated orbital fat, there is really not enough volume here to fill your circles.  I recommend finding a very experience injector to do this service.  Ideally you find this close to home because this service often needs adjustment to achieve the best possible result.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Under Eye Bags & Tear Troughs Respond Well To Volumizing Fillers In The Cheeks & Fillers Under The Eyes

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Treating the bags, tear troughs and dark circles under the eyes with injectable fillers and volumizers of the kind that you demonstrate in the photos has become routine treatment in the hands of experienced injectors. I must perform at least a  couple of these procedures every day. In the hands of a board certified aesthetic physician with expertise treatment the entire treatment session should not take more than about fifteen to twenty minutes.

Using a volumizing filler, such as Voluma XC to replenish the apparent loss of volume in the cheek region, particularly that portion below the lower lid, would be the essential first step to providing the necessary "scaffolding" to the lower lid, which can then be treated directly with a filler, such as Belotero Balance to camouflage the bags and dark circles and directly fill the tear trough.

Because it has little to no tendency to give rise to the unwanted bluish, Tyndall Effect when injected into the very delicate tissues of this location, Belotero Balance is typically my injectable of choice for this purpose in my Upper East Side Manhattan office. (In my Israel satellite facility, where a far greater number of regulatory agency approved fillers and volumizers are available, I would opt for Stylage XXL for the cheeks and Teosyal Redensity II for the immediate under eye region.)

The infraorbital area is not for the novice injectors trained to treat ordinary run of the mill smile lines. So make sure to carefully vet your treating physician and ask to see his/her before and after photos before proceeding.

Best of luck to you.

Nelson Lee Novick, MD
New York Dermatologic Surgeon
4.9 out of 5 stars 33 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.