What would be the best route to improve my under eyes? (Photo)

Yes, you are correct. There are many different ways to address lower eyelids so it could be confusing. I perform most lower lids with a transconjuctival approach because there is no risk of the lower eyelid drooping down. Fat injection helps smooth out the tear trough, and laser helps smooth out wrinkles in the skin. All together, a low risk procedure with a great improvement. Total cost is around $8000.

Based on the photos, you are candidate for lower blepharoplasty. It is important to keep eye shape and function the same. See an expert.

You are a great candidate for lower lid surgery. Every surgeon has their own specific technique. The biggest differences are fat preservation vs fat resection (moving or grafting fat to fill in the hollows or simply cutting the fat out) and transconjunctival vs transcutaneous approaches (incisions from inside the lid or outside the lid). In my hands, I would recommend a transconjunctival lower lid blepharoplasty with fat repositioning. This technique utilizes an incision on the back of the eyelid and removes the “bag” and fills in the tear trough to give a smooth appearance from the lid to cheek.
Best to see an eyelid expert.

Lower eyelid bags in patients with prominent eyes must be carefully managed.

I typically perform transconjunctival (incision hidden on the inside of the lower eyelid) lower eyelid blepharoplasty with fat repositioning. This helps avoid complications such as eyelid retraction and avoids post-surgical hollowing by preserving volume.

In many patients, I also typically recommend undereye / midface fat grafting to give a softer, more youthful, and more refreshed appearance. Even if every ounce of the fat bags are preserved and repositioning, it’s sometimes not enough volume to get a great result.

Some surgeons may either just remove fat or remove fat and perform fat grafting. The first option will causes hollowing and that does not look youthful. The 2nd option results in the surgeon needing to transfer more fat. I have been teaching other surgeons and performing fat grafting for a long time now and I can tell you the less you need to graft, the better. Also, the predictability of fat repositioning is much higher than fat transfer.

Don’t sign up if you’re not feeling right about your surgeon or your procedure.

You would benefit from a lower blepharoplasty with fat repositioning. This will not change the discoloration of the lower lids but will correct the concavity of the tear troughs.

Best Wishes,

Gary Horndeski, M.D.

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin in Winnetka and Chicago. This is a great question. Navigating treatment options for under-eye concerns can be daunting, especially when faced with varying recommendations from different professionals. At 36, you may be dealing with a combination of issues such as dark circles, puffiness, fine lines, or volume loss. Here’s a breakdown of some common and effective treatments for under-eye concerns and what might be recommended based on your specific needs:

1. Topical Treatments and Skincare
For mild under-eye issues, high-quality skincare can make a significant difference. Products containing ingredients like retinol, vitamin C, hyaluronic acid, and peptides can help improve skin texture, reduce dark circles, and hydrate the area. Caffeine-based creams can also be effective in reducing puffiness. Incorporating these products into a consistent skincare routine can address some concerns before considering more invasive treatments.

2. Injectable Treatments
For more pronounced issues such as significant volume loss or deep hollows under the eyes, dermal fillers are a popular option. Fillers like hyaluronic acid can restore lost volume and smooth out the under-eye area. They work by plumping the skin and reducing the appearance of hollows or shadows. PRP (Platelet-Rich Plasma) injections are another option, using your own blood components to stimulate collagen production and improve skin quality.

3. Laser Therapy
Laser treatments, such as fractional laser or laser resurfacing, can be effective for addressing fine lines, pigmentation, and overall skin texture. These treatments work by stimulating collagen production and resurfacing the skin, leading to smoother and more even-toned skin around the eyes. Laser therapy can be a good option if you have concerns about pigmentation or significant texture issues. Ultimately, the best treatment for you will depend on your individual concerns, skin type, and goals. I hope this helps and best of luck!

You have quite prominent eyes, and they sit anterior cheer to your cheekbone, which is referred to as a negative vector. There is skin excess and excess fat pockets. You have three issues for the best results all three should be addressed. Let’s start with a blepharoplasty to remove the excess orbit fat. The negative vector of the cheekbone can be addressed with fat grafting, fillers, or a Cheek implant. This will help to make the cheek look more prominent and lessen the effects of the negative vector for more harmonious look. The eyes would be align with the cheek or sit slightly posterior to the cheek. The final step would be to address the skin excess. This can be done by skin excision or skin tightening. Skin tightening can be accomplished with a CO2 laser thereby the skin is not cut. The skin excess can also be removed by cutting the excess skin. In cutting the excess skin, great care must be taken not to excise too much skin This can lead to a mal-position of the lower eyelids due to lack of support by the lateral canthal tendon. .

In my office I would recommend for you a lower lid blepharoplasty (tightening of the skin and muscle) and filler to the cheeks / tear troughs. You have two issues: (1) volume loss and hollowing - this is creating an indent which is exacerbating the aged look under your eyes. (2) sagging skin and muscle which are heading towards "festoons". We would surgically address this.

This combination will be the best. There are other lesser things like radiofrequency that can help somewhat, but will make less of a change.

It is important to understand that the upper cheeks are a major physical support for the under-eye region and any volume deficit in that crucial border area will negatively impact the appearance of the infraorbital regions. Accordingly, any improvement, which can be accomplished with the use of an appropriate HA filler properly injected by an experienced injector will smooth the transition between the upper cheeks and the under-eyes, there by diminishing the appearance of the bags. The results of treatment are typically immediate. Be cautious when being hawked fraxel laser, RF and other expensive energy-based treatments, since the hard science to support their use lags well behind the marketing hype and social media buzz to promote them. Likewise, surgery, besides being expensive, involves typically a prolonged period of post-op downtime and also carries the risk for the subsequent development of scar formation and even tram track stitch marks.
You would be wise to make sure consult an experienced, board certified cosmetic dermatologist filler expert. So take heart and best of luck.

In my opinion , the problem of your eyes are dark color, wrinkle and eyes fat pad.Dark color, you can collect it by filler injection, sleep efficiency more 85% and treat about allergic rhinitis if you got it.Wrinkle under eyes, botox is help a bit but it not good enough, it can do with soft filler injection .Eyes fat pad, about your age lower blephaloplasty is excessively, you can collect it by filler injection lower your eye and cheek area.