Surgery or Restylane for 35 yo? (photo)

I am interested in improving the appearance of my under-eye area. In my case, would you recommend Restylane injections or would surgery be necessary? What would be the recommended procedure? I am 35. Is it likely that the Restylane option might worsen the appearance of my eyes in the long run, after its effect wears off?

Doctor Answers 4

Fillers may work in your case of slight puffiness with adjacent hollowing, addressing also the eyelid-cheek area

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With the photo you submitted, it appears that you have a very thin face. There is also a slight bulge of puffiness under the eyes called lower eyelid fat prolapse. Lower eyelid fat prolapse is the fat around the eye that herniates and pushes forward so it looks puffy. Adjacent to the puffiness is a relative hollow. Hollowness may be manifested in the tear trough area which is the area adjacent to the puffy area. It may also be manifested below the tear trough area called the eyelid-cheek area sometimes called the V-deformity. In addition, the bone around the eye called the orbit previously had a little bit of fat. However, it has diminished over time and has become thinner so the bone structure becomes even more defined.

As a facial cosmetic surgeon who performs face lifting, cheek implants, and facial rejuvenation surgeries routinely, I look at the eyes and their context to the whole face. Very often, it’s a strategy about balance of doing not only the focal area of the eye but also to enhance the volume of the cheek. I always make a distinction between correction versus augmentation. When we talk about addressing volume loss and aging, this is more about correction.

In my practice, I first explain to my patients of how they would look when I address the puffiness under their eyes. However, understanding the overall appearance of their eyes may require more than just the reduction of the puffiness. I would often combine the surgical procedure with platelet-rich plasma as well as Restylane and fillers at the time of the surgery, or later on.

When patients like you are at a threshold wherein there is only slight puffiness, we can always do a trial procedure. A trial procedure is when I strategically place some Restylane, a hyaluronic acid filler, and combine it with platelet-rich plasma. Platelet-rich plasma acts synergistically with the volume effects of hyaluronic acid and improves the blood supply and skin quality of the area. A trial procedure can also help the patient look at herself in the mirror and decide if they like the look. And if they do, they can maintain it once or twice a year depending on how their body metabolizes the filler. Another benefit of hyaluronic acid is that that we can use an enzyme called hyaluronidase to dissolve the material if it is excessive or if it causes more puffiness.

If the filler does not adequately help reduce the puffiness, then a surgical procedure is the next step. A transconjunctival blepharoplasty is the recommended procedure wherein the fat is removed from the inside of the eyelid. By addressing the fat from the inside of the eyelid, there is no scar formation on the outside. However at this point, I think the very safe option is to do the injectables first. I also suggest that you meet with a qualified and experienced cosmetic surgeon who focuses a lot on the eye area. I hope that was helpful, and thank you for your question.

New York Oculoplastic Surgeon
4.4 out of 5 stars 80 reviews

Based on your photo, you may be a candidate for lower eyelid fillers.

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Your photo appears to show typical lower eyelid grooves that may be amenable to filling. The skill and product used by your doctor are critical for achieving a desired result. My personal preference is to use Silikon-1000, an off-label filler for permanent results.

Hope this helps you.

Dr. Joseph

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 435 reviews

Lower eyelid surgery or fillers

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At this point, your undereye area appears to have significant hollowing around the tear trough, midface and orbital rim, with only a minimal amount of fullness above the hollowed area. Fillers are a great option to smooth your lower eyelid area with minimal downtime. Adding volume can soften the hollowness under the eye and improve the transition to the cheek. If you develop more significant eyelid "bags" in the future, then surgery to remove this fullness is more appropriate. Restylane is a temporary filler and will disappear slowly over time and doesn't typically cause any long term changes to the appearance of the eyelid area.

Jessica Kulak, MD
Fairfax Facial Plastic Surgeon
4.6 out of 5 stars 27 reviews

Under eye surgery vs restylane

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It would be better to see a photo without makeup, but I suspect Restylane injections would help a lot. You have a mild amount of puffiness in the lower eyelids and have a lot of hollowing along the inferior orbital rim and your upper cheeks. I would recommend trying filler injections first, but would recommend treating both the lower eyelids and upper cheeks. You can always go with surgery at a later time if you are not happy with the results of the filler injections. There is no evidence that Restylane would worsen the appearance of your eyes as it wears off.

Mitesh Kapadia, MD, PhD
Boston Oculoplastic Surgeon
4.9 out of 5 stars 182 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.