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?
What Is The Best Way to Remove Crease Under Eyes? (photo)
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.
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.
Fillers for hollows
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.
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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 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.
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.
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.
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.
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
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.
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.