Genetic deep under-eye hollows - am I candidate for a blepharoplasty or filler? (photos)

Thank you for the question. Based on your photos, a combination of blepharoplasty and fat grafting to the mid-face would provide a youthful and long-lasting result. The blepharoplasty will remove the bulging under-eye fat with an incision on the inside that will be invisible, and the fat grafting will provide permanent fullness to the mid-face, which is a characteristic of youthful face. I hope this helps I wish you the best of luck. Vasileios Vasilakis, MD. Double board-certified, fellowship-trained plastic surgeon, Houston. TX.

At home peels like cosmelan, enlighten and aerify along with dermarolling (MTS roller with anteage MD ampules) should be started now. There are many things you can do to treat under eye hollows and dark circles. A surgical option to remove skin and/or fat will such as lower eyelid blepharoplasty with or without fat pad repositioning will be the best long term. There are many things you can do to treat under eye hollows and dark circles without surgery. Non invasive less downtime options such as fillers (Belotero, Juvederm Volbella​), lasers (Moxi/Halo/Fraxel/CO2​), Renuvion (J-Plasma), microneedling/PRP, stem cells and microneedling RF like Fractora PiXel8 or Morpheus can all help give some improvement. Accutite can often be used or stronger lasers like erbium or co2 spot treatment can tighten the skin and give very quick improvement in wrinkles and texture. A surgical option to remove skin and/or fat might be the best solution long-term. I suggest you get a formal consultation to see what is best for you and your goals. Best, Dr. Emer.

Volume deficit in the cheeks, which plays a major role in the development of under eye problems, such as tear troughs and bags, can be quickly and easily remedied with the use of a lifting filler, such as Restylane Lyft placed in the all important supporting region of the cheeks below the infraorbital region. This must be done in the appropriate way to maintain or create the more desirable, feminine, heart-shaped face shape and to secondarily improve the under eye issues--without creating pillow cheeks. Treating the tear troughs alone, on the other hand, without prior treatment of the underlying supporting cheeks predictably can lead to under eye puffiness and can often make the bags look worse. Once the cheeks are treated properly, Belotero Balance could be used subsequently should the infraorbital tear troughs and bags still remain an issue. You would be wise to consider consulting with a board certified cosmetic dermatologist. In experienced hands, treatment should take no more than about twenty minutes and typically gives rise to immediate "Wow!" reactions Best of luck.

Most expert experienced artistic plastic surgeons have a variety of procedures, both non-surgical and surgical, at their disposal to produce excellent cosmetic results in the appropriately selected patient: Botox or Dysport, temporary hyaluronic acid fillers like Restylane, long-lasting micro-fat grafts, blepharoplasties, or combinations of procedures. Each has benefits and drawbacks and depends on desired outcome and individual anatomy.

While Restylane filler may be a reasonable place to start, in a patient with your inherited anatomy, a blepharoplasty will produce the best and longest lasting cosmetic result.

Following the advice of anyone who would presume to tell you what to do without seeing photos and without taking a full medical history, examining you, feeling and assessing your tissue tone, discussing your desired outcome and fully informing you about the pros and cons of each option would not be in your best interest. Find a plastic surgeon that you are comfortable with and one that you trust and listen to his or her advice. The surgeon should be certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS). You should discuss your concerns with that surgeon in person.

Robert Singer, MD FACS

La Jolla, California

Please seek an opinion from a surgeon who performs mid-face lifting as a routine part of their lower blepharoplasties.

Although we used to treat people like you with blepharoplasty or mid-face lift, we have ceased doing so because the new fillers allow better correction with significantly less problems and risks. However, you must see an expert with intimate knowledge of the anatomy of the area. Unfortunately, this is only a small percentage of the physicians who treat this area. Most still use the wrong filler in the wrong place or try to correct it with a blepharoplasty. What you need is a heavy filler like Juvederm Volume placed deep on the bone or muscle below the different parts of the ligament.