Restylane or Fractional Laser? Or Worse, Do I Need Blepharoplasty? (photo)

Hi, I'm 35 and am very unhappy about the area under my eyes. When I'm not smiling I look tired with big bags under my eyes, and when I'm smiling I get both wrinkles and excess skin pushing up towards my eyes. I've looked into both Restylane and fractional laser. Would either of these help? Or both? Or do I need full on blepharoplasty? Thank you so much for your help. Emma

Doctor Answers 6

Combination Approach

Hello Emma,

It looks like you have herniation of fat and loose skin. Fillers probably would not fully correct the problem. The correct approach to your complaint would be blepharoplasty with an incision beneath your lashes. This will enable a small strip of skin to be removed in order to tighten the laxity of the tissue. Care must be given by the surgeon not to take too much skin or the lid will roll downward. After the small strip is removed, laser skin resurfacing can be performed to smooth out the remaining wrinkles and improve the skin texture to give an overall youthful appearance. I hope you find this helpful.

New York Oculoplastic Surgeon
5.0 out of 5 stars 144 reviews

I think you might have trouble getting a satisfactory lower eyelid filler treatment.

Fractional laser will be disappointing.  Fillers could help but you honest have a very complex lower eyelid for a under eye  filling.  Not impossible just highly fussy.  This often means multiple trips to the office for adjustment to make it right.  For these reasons, I have a hunch that you would be better off with a small lower eyelid arcus marginalis release transconjunctival lower blepharplasty with a chemical peel and a very conservative upper bleph.

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

Why fillers are so popular, but mostly not effective. Non-surgical procedures can treat your wrinkles, but eye bags need surgery

Puffiness in the lower eyelid is something called lower eyelid prolapse. This means that the fat that is normally around the lower eyelid pushed forward and created a bulge. People who have this puffiness would mostly consider lower eyelid blepharoplasty as a procedure after they have tried their homemade or over-the-counter remedies that did not work for them.

A few years ago, non-surgical physicians used decided that hyaluronic acid fillers such as Restylane was a non-surgical way to treat eye bags by camouflaging their appearance. However, this procedure does not work for a lot of people because it has a threshold of effectiveness. Patients who had Restylane injected were left with even bigger bags and puffiness in the lower eyelid. This is based on the fact the Restylane, in small amounts, can only soften the tear trough area and buy some time before the patient is ready for a definitive procedure.

The definitive procedure for lower eyelid puffiness is lower eyelid blepharoplasty. Over the past 20 years I have developed a process of doing this procedure with the most minimal trauma possible. I do this procedure under local anesthesia with LITE IV sedation. For most of my patients, I do this from the inside of the eyelid called transconjunctival blepharoplasty which leaves no external scar or incision.

After eyelid surgeries, patients often complain of having wrinkles or excess eyelid skin. Unfortunately, some surgeons address this problem by taking too much skin with the desire to improve wrinkles leaving the patients with pulled-down lower eyelids referred to as lower eyelid retraction.

In my practice, I address wrinkles with the use of Botox or Dysport that are injected to reduce the activity of a muscle called orbicularis oculi. When this muscle contracts, the wrinkles become deeper producing dynamic wrinkles. In cases such as static wrinkles, which are produced because of the loss of collagen in the skin causing it to thin, I would inject platelet-rich plasma. This material is derived from the patient’s own blood which contains the healing factors. We often combine this with fractional CO2 laser to help build up collagen and improve the vascularity or the blood supply of the skin improving the skin quality. I hope that was helpful, and thank you for your question.

Amiya Prasad, MD
New York Oculoplastic Surgeon
4.3 out of 5 stars 72 reviews

Treatment for eyelid bags and wrinkles

There are two things going on in your picture that need different treatments to correct.  The "bags" under your eyes are what is known as the "tear trough".  In younger patients like yourself, a filler such as restylane is a good option, especially since it looks like you have relatively flat cheekbones.  The skin wrinkles can be dealt with after fillers with either laser resurfacing or chemical peels.  A blepharoplasty can address both areas, but is both more invasive and more costly.  See a board-certified surgeon in your area to discuss which of the options might be best for you.

Jason J. Hall, MD, FACS
Knoxville Plastic Surgeon
5.0 out of 5 stars 11 reviews

Blepharoplasty versus fillers

It is apparent from your photographs that when  you are  smiling you have very little "excess skin" of the lower eyelids. You do have some pronounced fat of the lower lids. Fillers could improve the lower lids by "masking" the pronounced fat ,however,  a trans conjunctival lower lid blepharoplasty would be your best option .A   fractional CO2 lasering or a chemical peel will improve the lower lid lines but not eliminate wrinkles which occur with smiling . A conservative upper lid blepharoplasty could also be performed at the same time.

David F. LaPatka, MD
Santa Barbara Facial Plastic Surgeon
5.0 out of 5 stars 2 reviews

Options for under eyes

There are several treatments that can help with under eye problems.  For bags under the eyes, the longest lasting approach would be surgery.  The shorter lasting alternative would be using a filler, like Restylane, to place under the bags to help camouflage them.  Lasers can help improve wrinkles, as can surgery.  If you were going to have surgery for the bags, it would make sense to deal with the wrinkles surgically as well.  If you wanted to try something before surgery, you could try the Restylane and laser.  

Michael I. Echavez, MD
San Francisco Facial Plastic Surgeon
4.5 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.