I Am Sick Of Strangers Asking Me If I Am Tired; Lower Bleph, Mid-Face Lift or Fillers for Dark Circles/Bags?

I am in my early 30s but have had infraorbital hollowness and dark circles since I was a child, & now I have some fatty herniation. I am beyond tired of strangers in supermarkets asking me if I am tired. But, w/so many horror stories of tear trough fillers (on this website & the Internet), why are so many plastic surgeons promoting them? Tyndall Effect is not ok, even for people with prior hyperpientation. Looking for best result answer vs. most cost effective or least amount of down time.


Popular Question: Lower Bleph, Mid-face Lift or Fillers for Dark Circles with "Carry On" Baggage

Doctor Answers 6

Avoid Fillers For Dark Circles Under Eyes And Tired Look

Thank you for your important question. I agree with you that the potential complications of fillers injected into the thin eyelid skin should be avoided and in my opinion filler should rarely be used in the eyelids. I cannot tell you why this technique has become so popular among doctors although my guess would be that those who push their use likely are not skilled at doing blepharoplasty.

In my experience the trans-conjunctival blepharoplasty with fat grafting which is described in the link below is a very satisfactory, permanent solution for dark circles under the eyes, hollow eyes, and correction of eye bags or puffy eyes.

Be certain to consult a plastic surgeon who is certified by the American Board of Plastic Surgery or the American Board of Ophthalmology who has had specialized training an oculoplastic surgery. Aesthetic surgery of the eyelid requires an experienced specialist.

Lower Eyelid Hollows

Answering this without seeing you in person is complicated, however. . .

Typically someone who has hollows under the lower eyelids from a young age is an excellent candidate for a tear-trough implant.  Hollows at a young age are very much related to the shape of the skeleton and the implants directly correct that situation.  In addition, the fat that becomes visible with age in the lower eyelids can be blended into the upper cheek/implant area during the same surgery.  The surgery is done through the inside of the lower eyelid and thus results in no visible scars.  Healing is usually sufficiently progressed in about one week to return to work.

Louis W. Apostolakis, MD
Austin Facial Plastic Surgeon
4.9 out of 5 stars 30 reviews

Weigh your options

With every one horror story, there are hundreds of success stories. Patients tend to only share when something isn’t right. With ANY procedure there are risks involved.
You need to be examined by a Board Certified surgeon. He/She will be able to explain different options and their risks and allow you to choose which step you want to take. It comes down to the skill of the surgeon and the confidence you have in them. Have more than one until you are find the right one for you.
Good luck with your search!


Philip Young, MD
Bellevue Facial Plastic Surgeon
4.2 out of 5 stars 84 reviews

No procedure is risk free, however...

Firstly, photos would be helpful for us to give you a more specific recommendation. In response to your statement regarding "horror stories". It should be realized that for every "horror story" that you read online, there are probably 99 successes that are not publicized.


There is almost always more than one way to approach eyelid hollowing/bulges. Both surgery [fat excision, repositioning, fat injection]  and fillers have their place in our practices. It depends on patients expectation, preference, anatomy, and surgeon experience which technique is offered.

Have consultations with experienced surgeons that have more than one "trick" up their sleeve.


Good luck

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 37 reviews

Solutions for tired looking lower eyelids and deep tear troughs

The best way to answer your questions is to have an in person consultation to evaluate all your options both surgical and non-surgical and review the risks and benefits of each option. If you are having significant issues with your current appearance, then you are looking for improvement not perfection with any intervention. Filler injections including fat are minimal down time but not without risks which are mainly cosmetic. However, while improving the infra-orbital hollowing, they do not improve skin excess or texture. Surgical options such as traditional blepharoplasty with removal of infraorbital fat or repositioning is the most aggressive and longest recovery (3-7 days) but also with the best results long-term. Silicone tear trough or combination Implants may be an excellent in between option with regards to longterm improvement and quick recovery after a small surgical procedure. Fillers such as Hyaluronic acids (Juvederm) are better than calcium hydroxyapetites (Radiesse) for tear trough injections and minimizing the tyndell effect but are extremely provider dependent. Lastly, I've had good experience with autologous fat transfer for mid face and peri-orbital volume enhancement and in the right patient, can offer a natural, semi-permenant correction. The most important factor is choosing an experienced surgeon to review all your options and possibly consult with more than one surgeon before deciding on the course of treatment and the provider. Shop for the best surgeon and not for the best price.

Edwin Ishoo, MD
Cambridge Facial Plastic Surgeon
4.4 out of 5 stars 20 reviews

Treatment for "tired" lower eyelids

Unfortunately, it is difficult to discuss the best option for you without an examination.  In terms of the least amount of downtime, you are correct that fillers (particularly restylane) are excellent for improving the appearance of the tear troughs.  One thing to keep in mind is that NO procedure, even minimally invasive ones, is risk free.  Yes, lower eyelid fillers run the risk of the tyndall effect or nodules, but the risk is minimal if done in the right hands using the right filler (most people believe that these issues are more common with juvaderm).  Similarly, surgery has its own sets of risks.  I would recommend that you consult with a board certified plastic surgeon and discuss what would be best for you in terms of risks vs. benefits, downtime, and the most cost-effective.  Good luck!

Anureet K. Bajaj, MD
Oklahoma City Plastic Surgeon
5.0 out of 5 stars 18 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.