30 yr old female looking for a long lasting alternative to blepharoplasty to correct under eye circles. Any suggestions? (photo)

I have hereditary circles under my eyes that make me very self conscious. I would like to have corrected but blepharoplasty requires too much down time for my lifestyle. What are my options?

Doctor Answers 12

Alternative to blepharoplasty

Restylane is a wonderful filler that can last many years beneath the eyes. I have had this done beneath my own eyes and have seen results for over 8 years with just a small touch up (not redo) at about 6 1/2 years, at which point we were able to verify residual effect using 3D imaging. Synthetic fillers have limited downtime (a day or two of swelling at most in most cases ), but you could consider fat transfer for even longer results, albeit with longer downtime. 

Dr. Donath 

Cincinnati Facial Plastic Surgeon
4.8 out of 5 stars 37 reviews

30 yr old female looking for a long lasting alternative to blepharoplasty to correct under eye circles. Any suggestions?

Judging from your appearance in your submitted photograph, you have protruding fat pockets in your lower eyelids. As you mentioned, this is hereditary. The shadow beneath the fat pockets (commonly called "bags") is what gives you the "dark circles" under your eyes.

You mentioned long-term correction, and this can only be achieved by removing the excess fat mentioned above. My choice would be removal of the fat through an incision inside your lower eyelid, called a trans-conjuntival blepharoplasty. This can be done under local anesthesia, and there are no sutures to be removed. Your recovery time should be just a few days. Any bruising can be covered with makeup.

If you do have a lack of volume over the infra-orbital rim, some of the fat removed can be inserted into this depression (which is where your dark circles are now). This can all be done through the same incision inside your lower eyelid.

Injections of fillers into the hollow beneath your lids are temporary and would certainly not fulfill your quest for a more permanent correction. In fact, it would not offer much correction at all because your primary problem is the excess fat in the "bags", not the depression below the bags. You have to decide which is most important to you, a temporary break in your "lifestyle" or eliminating your problem once and for all.

Good luck with your quest to correct your lower eyelid problem. I'm sure you will be elated with the result.

E. Ronald Finger, MD
Savannah Plastic Surgeon
4.8 out of 5 stars 78 reviews

Puffy Eyes

The lower eyelid and the midface will frequently have to be considered together.  Problems we see include bulging of fat, hollowing over the infraorbiotal rim, skin wrinkles and excess and descent of the mid-face.  This is a bit oversimplified but covers most of the issues.

Now... what one does to correct these undesirable features is dependent on the patients desires, the patients anatomy and the skill set of the surgeon.  Single methods and combinations of methods are performed and include at least: filler and fat injection, variations of blepharoplasty and variations of midface lifting.  I personally perform most of these procedures but really decide what is best after I meet with the patient and examine their tissues.  Then the patient and I move toward solutions.

The best answer for you is to arrange for a consult with a credible surgeon and I  am confident you will find the best solution for you.

Best regards,

Fred Fedok, MD FACS

Fred G. Fedok, MD, FACS
Mobile Facial Plastic Surgeon
5.0 out of 5 stars 10 reviews

Treatment for Under Eye Circles

The dark circles under your eyes caused by depressions in the area can be permanently corrected with surgery or temporarily camouflaged with fillers. Surgery would require a fat-repositioning lower lid blepharoplasty. In this surgical procedure, fat from the eye area is moved into the tear trough depression filling the depression.

There are great non-surgical option to fill in under eye depressions and hollowness. Using dermal fillers, a liquid eyelift can be performed. Dermal filler such as Restylane would be placed in the cheek and tear trough to hide the depression or bag underneath your eye.

Many times patients will try the non-surgical option first to see if they are happy with the result. If they do not get the results that are seeking, they can still undergo surgery. Other patients want a permanent solution and choose to undergo surgery.

At times, patients will have a darkening of the skin in this region. This staining of the skin can be difficult to treat and will not improve with either a liquid eyelift or a lower blepharoplasty.

Each of these choices are viable options. I would carefully review the pros and cons of each procedure and decided what would be best for you.

Jonathan Kulbersh, MD
Charlotte Facial Plastic Surgeon
5.0 out of 5 stars 66 reviews

Without Surgery long lasting treatments are less

Without surgery, it is hard to have any permanent effects. Fillers can help and have some temporary and small permanent effect. To remove that puffiness, the fat in the eye socket has to be removed. That is all there is to it. 

Chris Thiagarajah, MD
Denver Oculoplastic Surgeon
4.9 out of 5 stars 9 reviews

Blepharoplasty alternative treatment option

Dermal Fillers are commonly used as a temporary treatment for lower eyelids related concerns. A series of Radio Frequency treatment such as Venus Freeze can be proven effective. Please consult with a skilled healthcare provider to address your aesthetic goals.

Sarmela Sunder, MD
Los Angeles Facial Plastic Surgeon
5.0 out of 5 stars 19 reviews

Transconguntival fat transposition Blepharoplasty

 light anesthesia in the office with an inside the lid approach to use the bulging fat to help the real problem, the sunken area underneath or dark circle.  Up and about in one day but with sunglasses if you wish to go out. Long predictable results. Filler a distant second choice.

good luck

J. Smythe Rich, MD
Columbia Facial Plastic Surgeon
4.6 out of 5 stars 24 reviews

Eyelid surgery vs fillers

You really only have two good options.  Lower eyelid blepharoplasty with fat transposition and muscles tightening will give you the most natural and significant result.  Stitches are usually out at 5 days and the most of the swelling and bruising is gone in the first two weeks. But you can wear glasses to cover.  

Filler will ill give you good improvement I you can't do surgery.  Use either restylane or belotero and you can fill the anterior cheek just under the tear trough and help bolster that area to get rid of the shadows seen 

Ben Talei, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 46 reviews

Lower lid bags

You can have fillers injected to achieve conservative and temporary improvement or have a surgical blepharoplasty for "long-term" improvement. There is no such thing as a long-lasting alternative to surgical blepharoplasty in your case.

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

Bags lower lids

I don't know of any LONG lasting non surgeical solutons.You could put fat or fillers under the protruding bags but that will only be temporary.You could do a transconjunctival bleph ie the incision is on the inside of the eye and NOT on the outside.

Robert Brueck, MD
Fort Myers Plastic Surgeon
4.9 out of 5 stars 62 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.