What Is The Best Way to Remove Crease Under Eyes? (photo)

What is the best way to remove a crease under the eyes? Fillers? Fat transfer? Blepharoplasty? Skin pinch? I am 30 and ideally would like to add more fat to the area but am wondering if the line could ever be filled in or if I would need a more invasive procedure? Also, would an upper blepharoplasty be best to remove the hooding that is beginning to form in my upper eyelids or is this something that can be achieved with a fat transfer or filler to the brow?

Doctor Answers 15

Lower eyelid crease and upper eyelid concern

Though it is impossible to give a definitive opinion without an examination in person, the photos you provided are quite helpful. The lower eyelid crease is a hollowness that is most likely hereditary or simply genetic in your case. It is due to lack or absence of fat in that area and needs filling to provide a smooth restful-looking transition between your lower eyelid and your cheek without the shadow it is currently creating.

Fillers like Restylane or Juvederme Plus are preferable to thicker fillers like Perlane, Juvederme Ultra Plus or others, because of the thin skin in that area and the lack of "padding" between the skin and the underlying bone. This may increase the chance of lumpiness with a thicker filler. Fat is also a good option but considering your age, it is better to wait. Fillers have a good longevity in this area.

Your upper eyelids are perfect. They truly need nothing. They are the kind of eyelids we aim for when we perform upper eyelid surgery.

No surgery, skin pinch included, is indicated in your case.

All the best.

Montreal Facial Plastic Surgeon
4.8 out of 5 stars 77 reviews

How to smooth lower eyelid creases

Your eyes/eyelids are very beautiful, and the first priority is to preserve all of the beautiful elements.  The lower eyelid/cheek junction is a distraction from your beauty, and may be camouflaged by filler, nearly always my first choice for someone in your age group.  Juvederm Ultra Plus or Perlane should work nicely, or perhaps Radiesse.  Of course, in person examination, consultation, discussion of possible choices, risks, benefits, expected longevity, etc. should precede any treatment.

Steve Laverson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 46 reviews

Fillers for hollows

I have seen many patients with that hollowness under the eyes, which causes the appearance of dark circles. This can be corrected by filling in the hollowness with an injectable filler.

I would suggest not undergoing surgery at your age for the hooding of your upper eyelids. Your eyes are bright and beautiful as they are.

Leila Kasrai, MD, FRCSC
Toronto Plastic Surgeon
5.0 out of 5 stars 66 reviews

Upper / Lower Eyelid surgery in a young patient

From your photos, it is difficult to assess what is necessary for your lower eyelids.  It could be that you just have a small amount of fat excess creating your bulges / shadowing, and a transconjunctival bleph is all that is necessary.  I do not think you have any lower eyelid skin excess.  Other possibilities are that you have strongly adherent skin to the lower orbit (creating the naso-jugal trough), and that an arcus release is necessary.  Additionally, you could have an intrinsic skin color difference that could potentially be addressed with a peel, but I am not a fan of peels in patients with darker complexion due to risks of undesirable skin color changes.  I do no suggest fat grafting to the eyelids, as the "random" nature of resorption under such soft skin can lead to visible irregularities.  Your upper eyelids definitely do NOT need any fat - you have a nice high eyebrow arch with a good bony rim show.  The only thing I would consider for your upper lid is a small amount of skin removal to sharpen the lid crease.

Best regards,
Dr. B

Michael A. Bogdan, MD, FACS
Dallas Plastic Surgeon
4.9 out of 5 stars 67 reviews

Best Way to Remove Creases Under Eyes

Under eye creases can optimally, depending on the age of the patient, be improved with filler and/or by skin pinch removal. If you have skin redundancy or if you have skin pinch then a lower eyelid blepharoplasty will work well in this area. For fine wrinkles, one can use laser resurfacing or a chemical peel.

Rod J. Rohrich, MD
Dallas Plastic Surgeon
4.9 out of 5 stars 61 reviews

Removing crease under the eyes

The crease that is present beneath the lower lids is due to shadow effects that are caused from herniation of the orbital fat pads.  This is best addressed through a transconjunctival approach with a conservative removal of fat in both the middle and medial compartments of the lower lid.  With respect to hooding of the upper lids, a small elliptical excision of excess skin can be removed from the upper lids to deepen the upper lid crease and remove excess fat in both the middle and medial compartments. This is done through an incision directly in the crease and closed with dissolvable sutures.  The blepharoplasty procedure is performed under a general anesthesia and takes approximately an hour to perform.  

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 reviews

What Is The Best Way to Remove Crease Under Eyes? (photo)

Many options or combination of options. Easiest is Restylane filler. Than Fat grafting, than transconj bleph., or a combination of these options. Always best to be seen in person by a boarded PSs in your area. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 173 reviews

Eyelid rejuvenation

Your upper lids are best addressed with volume augmentation (filler injection).

Your lower lids are probably best addressed the same way, although surgery may have a role. It is difficult to tell without closeup examination.


Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 72 reviews

Best Way to Remove Crease Under Eyes?

Frankly, I think you have almost perfect eyes. I think operating on your operating on your upper lid borders on the criminal. There is NO way the upper lid can be improved upon. The corners of the eyes are perfect with the side corner about 2 mm higher than the inner corner (canthus) the way a youthful eye should be. The almond shape is gorgeous. There is minimal sag of the lower lid with about 1mm of scleral (white) show. There is darker discoloration of the lower lid with a pronounced Nasojugal line. I think minuscule amounts of fat grafting under the lower lid skin would decrease the dark pigmentation but the trough could be filled with either Restylane or careful fat grafting to raise and smooth the groove.

Peter A aldea, MD

Peter A. Aldea, MD
Memphis Plastic Surgeon
4.9 out of 5 stars 108 reviews

What Is The Best Way to Remove Crease Under Eyes?

From the photos, it appears that you may have malar bags that should be evaluated by a plastic and cosmetic surgeon or occuloplastic surgeon before you consider having any fat transfer, fillers or surgery.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 24 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.