Filler Under my Eyes After a Blepharoplasty and Laser Surgery?

Or is there other options to help me? Im a 36 year old female who decided to get a few wrinkles out of the way...nothing to severe. I didnt do enough research on the procedure. I also got laser resurfacing underneath as well. It has now been 8 months and am in tears of the results. I look back now and nothing was wrong with my eyes. The doctor gives me botox injections right beneath the eye but this is a life long thing i never expected. My eyes look hollow more wrinkes and loser. I am in tears at 36 and cry myself to sleep. I dont know what to do? My surgeon suggests resurfacing again...or a filler parlene...or making a small insiscion underneath the eye to take away the saggy look...but i am very scared they will get worse? What about a fat transfer?Should i do it or is there something better to resolve this. I find my skin beneth my eyes very thin me please. I use to be an attractive feel like hiding away in a hole due to this procedure.

Doctor Answers 17

Slow down with the eyelid procedures

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.

Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Fat injections are the way to go

We are embarking on a new frontier in volume replacement. Fat injections, if done well, do not clump. If they are done with large needles, poorly prepared, and injected in irregular volume, then lumping can occur. However, newer techniques, including the Viafill system (available in May), will allow for smooth, long-lasting fill. Fat also has stem cells in it that will help to thicken the crepey skin you complain about. Find a good doctor who performs fat injections regularly.

Robert M. Freund, MD
New York Plastic Surgeon
4.8 out of 5 stars 33 reviews

Correction after Blepharoplasty possible

In tears,

Correction of your present condition can probably be done. I would suggest consulting with another surgeon to see if the recommendations are similar. If so, staying with the original surgeon would save you money, as he/she should correct it pro bono. If the recommendations are different, consider even a third consultation. Good luck!

Kenneth R. Francis, MD, FACS
Manhattan Plastic Surgeon
4.6 out of 5 stars 46 reviews

Hollow eyes after Blepharoplasty

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.

Daniel Reichner, MD
Newport Beach Plastic Surgeon
4.9 out of 5 stars 45 reviews

Options following Blepharoplasty

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:

    1. If you don't like it, it will wear off or you can reverse the products with off label use of hyaluronidase.
    2. 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.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 81 reviews

You must be carefully examined

Blepharoplasties can be one of the easiest procedures to do, but the periorbital anatomy is more complex than most appreciate. Your anatomy will dictate what options you have. You cannot look at wrinkles in isolation nor hollowness nor bags. Each can be caused by a multitude of anatomical structures and their relationship with each other. Bags do not always mean you should have fat removed. Hollowness is not always correctable by fillers. Wrinkles can be overtreated by resurfacing.

No one can give you recommendations without a meticulous examination of your bones, fat, muscles, skin and their respective amounts, quality, and relationship to each other. Even though you have been unhappy for 8 months, you do not need to rush into things. Do your homework and speak with a couple of board-certified plastic surgeons.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 11 reviews

Multiple eye procedures carry risks

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.

Steven H. Williams, MD
San Francisco Plastic Surgeon
4.8 out of 5 stars 49 reviews

Lower eyelid blepharoplasty results

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.

Anil R. Shah, MD
Chicago Facial Plastic Surgeon
4.8 out of 5 stars 162 reviews

Answer to your question

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

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

Fat transfer works for hollow under eyes.


I am sorry to say you have a very difficult problem. You need to find a plastic surgeon or an oculoplastic surgeon with experience doing fat transfer (fat injections) for the tear troughs and the under eyes which are hollow. This can work well but is difficult.

I don't have a permanent solution for the wrinkled skin.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
4.8 out of 5 stars 9 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.