Filler Under my Eyes After a Blepharoplasty and Laser Surgery?

Dear Intears,
It is very common to be dissatisfied with the results of lower eyelid surgery, especially for someone who is as young as you are.
You should be more aware than most that it is easy for a surgeon to promise you the sun, the moon, and the stars, and then not deliver. After surgery, they may tell you your issues are minor, will get better it time, or that you're simply wrong and this is the way it is supposed to look.
The fact of the matter is that eyelid surgery is an art form, an exercise on dancing on the head of a pin. Yes, we can all show you great looking before and after pictures but in the final analysis, this does not mean these procedure will solve your problems. This is an area that benefits from a less is more approach.
My prospective is that I am in the business of fixing other surgeon's bad eyelid results. Let me tell you that you probably have legitimate concerns. You probably did not need all the surgery you got initially. However, no one can factually assess your situation without a personal consultation. I can tell you that you should be skeptical of any surgeon who proposes a fix for you after having spent less than 40 minutes with you in consultation, speaking with you and examining you.
Will fat grafting fix your problem?-probably not. It may help the hollow but it can also cause unwanted lumps and is ultimately unpredictable and difficult to improve if it heals unevenly. The lower eyelid wrinkles may be due to damage to the normal gliding planes in the lower eyelid.
What should you do? Don't rush off to have more laser resufacing or even eyelid surgery. Seek out other opinions even if you have to travel to get these. Find what makes sense. Don't just resign yourself to working with your original surgeon who got you in trouble in the first place. Temporary under eye filler, like Restylane, can be helpful in these circumstances but it is in your best interest to find someone with a great deal of experience with this type of treatment.
Good luck and feel free to contact the Realself community with additional questions.

As we age, we lose fat that overlays the orbital bone under the eye. This, along with the general sagging that occurs in the face, can result in loose, hollow areas under the eyes, much like a balloon that is losing air. Fat grafting can restore a youthful appearance under the eyes in a very natural manner by "blowing the balloon back up." The results can be long lasting and the procedure is easy to undergo. Good luck.
Dr. Miller

Lower eyelid blepharoplasty results are obviously best assessed in person.  When there is persistence of lines under the eye after a lower lid blepharoplasty many anatomic questions must be assessed including the following:

Is there extra skin present?  Not all patients are candidates for a transconjuctival blepharoplasty and have too much skin present preoperatively.  Removal of extra skin can be the best option for the right patient.  (i have a link to a paper discussing a new technique myself and a colleague have recently described here)

How does the lower eyelid relate to the cheek?  While eyelid surgery from even 10 years ago was a subtractive surgery, aggressively removing fat from the eye, more recent advances are now seen in some cases augmenting around the eye area

What is the condition of the skin?  Sun damaged skin may need a variety of approaches to address fine lines here.

Yes, often when there is a residual hollow area at the outer orbital rim of the lower eyelid a filler can treat this. I prefer to use the eyelid fat to transpose in this area during surgery. But a filler can always be used if necessary to give good results.

I don't have photographs of your eyes so it is difficult to give you specific advice. That being said, it sounds like your surgeon performed a traditional lower blepharoplasty and was too aggressive. There has been a paradigm shift in Plastic Surgery with regards to the way surgeons perform lower blepharoplasty. We have noticed that over resection of lower eyelid fat has changed the way Plastic Surgeons approach this procedure. The trend is toward conservation of the lower eyelid skin, preservation of lower orbital fat and actually micro fat grafting to fill the tear-trough depression.
I would recommend that you seek consultation with a Board Certified Plastic Surgeon comfortable with micro fat grafting of the cheek and lower eyelids. I would recommend a two stage approach. First, start with fat grafting to correct the lower orbital and tear trough volume loss. Second, once volume loss is corrected, determine the degree of skin tightening required and either resurface or remove any loose skin.

IF your skin is too thin, I would avoid any additional resurfacing techniques.
There are few products or techniques to "thicken" the skin. One of the few products to actually thicken the skin are retinoids. However, you must exercise extreme caution in the use of these products around the eyes.
IF your eyes are hollow-looking, you could contemplate the use of a filler. Hyaluronic products such as Perlane, Juvederm, Restylane, and Prevelle are commonly employed here. There are two potential advantages of these products:


If you don't like it, it will wear off or you can reverse the products with off label use of hyaluronidase.
If you do like the results, you can use it as a stepping stone to trying a longer term solution such as lipoinjection or fat grafting.


Try to take your time in making a decision and don't rush or feel pressured into making a commitment.

Some patient has similar concerns after lower lid blepharoplasty as you do. I often feel that surgeons are too aggressive with taking out fat from the lower lids. This often leaves a sunken or hollow look. At this point, you may consider fat grafting to replace the missing volume. Also another round of resurfacing or TCA peel may be helpful. As long as your eyelid maintains it strength - that is, it is not loose or pulling away from your eyeball - then you can safely undergo further procedure. However, make sure you are seeing a qualified surgeon before having any surgery around the eyes. Good luck.

I'm sorry to hear about your concerns about the results from your lid improvment procedures.
There are many different techniques that can be used to improve your condition. However, you should proceed with caution. Multiple eyelid procedures carry the risk of creating problems with your lid's ability to protect your eye (conditions like ectropion).
First, be sure you've given enough time for healing, this can take up to a year. In addition, when you're being evaluated for revisionary surgery, Botox may camoflage issues that should be corrected at the time of additional lid surgery, so be prepared to be off of Botox for several months.
Find a board certified plastic surgeon or occuloplastic surgeon to help with what may be a complicated problem.
I hope this helps.

First I am sure you are still an attractive girl. Secondly, filler and fat grafts can sometimes help in this situation. 

Structural fat grafting can be used for upper or lower eyelids and is often used to correct aggresive blepharoplasties where too much skin and or fat has been removed.
Structural fat grafting uses small amounts (less than 0.1 cc at a time) of fat are carefully microinjected in a series of discrete layers to gradually 'build' new soft tissue structure. As there is space between each microinjection, new blood vessels are able to grow into the grafted fat, allowing it to persist. If this process of blood vessel ingrowth (neovascularization) does not occur, then the injected tissue cannot truly be considered a 'graft' and is instead just another 'soft tissue filler' of limited duration.
Any revisional surgery is at least a bit more challenging than a first time surgery. Take your time researching plastic surgeons and look for a fat grafting specialists who regularly performs fat grafting and who does have experience with revisional eyelid surgery. Good luck to you.