​ ​I have bags/ folds of skin under my eyes, would you recommend Eyelid Surgery or fillers? (photos)

I've always had 'folds of skin'/bags under my eyes...not fat bags, but actual little folds of skin. I'm going to have revision rhinoplasty and the doctor suggested a lower-blapheroplasty (sp?), saying that i had too much muscle and skin and that he would reduce that and do fat grafting. I'm scared of the fat grafting, w/thin skin. Surgery OR doing some HYALURONIC ACID fillers ? I will do botox again soon. THANK YOU!!!

I have bags/ folds of skin under my eyes, would you recommend Eyelid Surgery or fillers? (photos)

Doctor Answers 9

Undereye treatments

Filler for your undereye area and Botox for your crow’s feet could be sufficient to achieve the results you want. However, a lower eyelid lift (blepharoplasty) would be more effective if you have any bulging fat.

Toronto Plastic Surgeon
5.0 out of 5 stars 66 reviews

Lower eyelid surgery

Fillers help with one aspect of the ageing process - volume loss.  Eyelid surgery can help with volume loss as well as with skin redundancy.  Your surgeon is proposing to treat the excess skin and volume loss together by a blepharoplasty.

Michael B. Tantillo, MD
Boston Plastic Surgeon
4.7 out of 5 stars 29 reviews

Eyelid Surgery or fillers?

Fillers often can produce a nice temporary cosmetic improvement in some patients, but not all. They certainly do not achieve what a well performed blepharoplasty will do.

Fillers can help improve the cosmetic appearance but you will get only a temporary and limited improvement with them. A better and long standing correction would be achieved with a blepharoplasty of the lower lids: Conservatively removing any excess loose skin that may be present, smoothing the tear troughs with micro-fat grafts or fat repositioning.

Keep in mind that following advice from a surgeon on this or any other website who proposes to tell you what to do based on two dimensional photos without examining you, physically feeling your tissue, assessing your desired outcome, taking a full medical history and discussing the pros and cons of each operative procedure would not be in your best surgery. I would suggest that you find a surgeon certified by the American Board of American Plastic Surgery and one who is ideally a member of The American Society for Aesthetic Plastic Surgery (ASAPS) that you trust and are comfortable with. You should discuss your concerns with that surgeon in person.

Robert Singer, M.D., FACS

La Jolla,California

Robert Singer, MD
La Jolla Plastic Surgeon
4.6 out of 5 stars 19 reviews

​I have bags/ folds of skin under my eyes, would you recommend Eyelid Surgery or fillers? (photos)

Hi Wonderingifwhen,

Looks like you would be a great candidate for BOTOX since it is approved for the crowsfeet about 20-24 U would help to alleviate the wrinkles. A Hylauronic Acid filler might also be helpful to give that area a fuller and smoother look. Your surgeons suggestions could also work for a more long term improvement.

Hope this was helpful!

Kristin J. Tarbet MD, FACS
Bellevue Oculoplastic Surgeon
4.9 out of 5 stars 23 reviews

Aesthetic issues of the lower eyelids can be dealt with by injectables or with surgery.

I think you could get satisfactory aesthetic improvement with Botox possibly some filler. Lower lid blepharoplasty should yield a very good result however in would be worthy of consideration.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.7 out of 5 stars 35 reviews

​ ​I have bags/ folds of skin under my eyes, would you recommend Eyelid Surgery or fillers? (photos)

Your concern is the excess skin and the wrinkling around your lower eyelids. I recommend lower blepheroplasty, canthopexy along with Botox to the crow's feet areas at the corners.
I am not a fan of fat grafting around the eyes. The skin is too thin. 

Maan Kattash, MD, FRCS, FACS
Los Angeles Plastic Surgeon
5.0 out of 5 stars 53 reviews

What to do for your eyes?

Thank you for the photos. You have multiple options and it all depends on how much you want done. The simplest is some type of neuromodulator agent (botox, xeomin, disport) around the eyes. This will help reduce the lines, a little can also be placed into the lower eye lid if needed, this can be determined on examination. 
Then a lower blepharoplasty would also definitely help, primarily to remove excess skin, this would require more down time, but would definitely give you better results. A filler can always be done and if you are afraid of a fat transfer, then yes, a hyaluronic acid filler can be placed to further improve any volume loss you may have under your eyes. Good luck!

Dilip D. Madnani, MD, FACS
New York Facial Plastic Surgeon
4.9 out of 5 stars 89 reviews

Eyelid surgery not fillers for lower eyelid folds

First, Botox will significantly reduce the wrinkling in the corners of your eyes called the crows feet.

Some form of skin resection blepharoplasty will help reduce the extra folds on your lower eyelids when you squint.

However care must be taken to avoid shortening the lid too much so that it could pull the eyelid downward.

In addition even after blepharoplasty when you squint or smile the muscles beneath the skin will constrict into full.  Please consult an expert board certified plastic surgeon who is experienced in eyelid rejuvenation.


Surgery is the only thing that is going to get rid of the excess skin and muscle.  Does the surgeon want to use fat grafting to fill in the hollows?  It's hard to tell by your pictures if you are going to be hollow but fat SHOULD stay longer around your eyes than filler, though filler is an option.  It can always be done at another time but will cost you more money for a separate procedure.  I would also recommend some CO2 laser to improve skin texture and botox around the eyes to soften the lines on top of the cheeks/around the eyes.  

Jan Zemplenyi, MD
Bellevue Facial Plastic Surgeon
5.0 out of 5 stars 16 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.