Restylane or lower eye surgery? (Photo)

I have deep tear troughs with black circles under my eyes. However on top of that I have lots of wrinkles when I smile. Would like to know what is the best route to make my eyes look better. 47 years of age.

Doctor Answers 11

Be careful.

Injecting the tear trough with a hyaluronic acid filler like Juvederm or Restylane is RARELY a good idea. Why?  Because the chance of making you look swollen and strange is very high.  The photos you show are limited and therefore it's difficult to give you a comprehensive recommendation. Most likely, you would benefit from improvement of cheek volume.  I like Sculptra the most to improve volume in the cheeks.   I would advise you to see a board certified plastic surgeon who can give you an expert and honest opinion about what would help improve the aging face.  Good luck!

Restylane or lower eye surgery

Dear renatelee, 

Thank you for your clinical post and photograph. The tired appearance of the lower lid with a slight bag, tear trough and hollow with fine lines can be improved both surgically and non-surgically. As a plastic surgeon with over 20 years in blepharoplasty experience, certainly the best result would be achieved with blepharoplasty surgery, which can be performed under local anesthesia involve reduction of the fat pad and smoothening of the skin. This, of course, involves some recovery and a small amount of risk but gives you the best long-term result. Temporary results lasting 8-12 months can be achieved with soft tissue fillers such as Restylane under the eye, near the tear trough with fractional lasers, Botox and non-ablative radio frequency heating nice improvements can be achieved although they are less permanent and less impressive than with surgery.
Either way I think you should get a consultation with an experienced blepharoplasty surgeon who also does non-surgical treatments.

I’m sure you’ll get an excellent result and best of luck.

To find out more or schedule a consultation, please visit the link below.

R. Stephen Mulholland, M.D.
Certified Plastic Surgeon
Yorkville, Toronto

R. Stephen Mulholland, MD
Toronto Plastic Surgeon
4.6 out of 5 stars 83 reviews

There are several issues so rejuvenating your eyelids will take a combination of surgical and non-surgical treatment

Thank you for your question. You state you have deep and dark under eye circles and some wrinkles when you smile. You’d like to know whether Restylane or eyelid surgery can help you.

I can certainly help you with this question – I’m a Board-certified cosmetic surgeon and a Fellowship-trained oculofacial plastic and reconstructive surgeon, practicing in Manhattan and Long Island for over 20 years. I was first trained in eye surgery, before further specializing in plastic and cosmetic surgery around the eyes. Eyelid rejuvenation is also a very big part of my practice.

Looking at your photos, it seems like there may be some puffiness in the left eye, as well as hollows and wrinkles. When it comes to eyelid rejuvenation, these are usually the most common issues that we address, as these are what bother people the most. Keep in mind thatin the absence of a full proper evaluation with a physical examination, I am simply giving you information as to what I personally do in my practice.

Treatment for under eye puffiness is usually quite straightforward – if the puffiness has always been there, then it is likely caused by a condition called lower eyelid fat prolapse. This means that fat that is normally around the eyes has pushed forward and results in a hernia, or what we call herniated fat. To remove this, we perform a lower eyelid transconjunctival blepharoplasty from the inside of the eyelid. From there, the displaced fat pockets are directly addressed.

For under eye hollows, we do a combination ofhyaluronic acid filler, such as Restylane, and platelet-rich plasma, which is a concentration derived from your own blood and containswound healing and growth factors that generate collagen and blood supply. We’ve gotten some very nice results from this combination treatment.

As for wrinkles and lines, it is important to remember that there are two types of lines: static and dynamic. Static lines appear even when you’re not smiling, while dynamic lines appear when you do smile. Dynamic lines are usually treated withdrugs like Botox™, Dysport, or Xeomin. These work by relaxing the muscles that cause the lines, and do require some maintenance. Static lines, on the other hand, can be addressed by means of a fractional CO2 laser. This treatment takes off the top layer of the skin and contracts the skin, thus creating a tightening effect.

I recommend that you meet with experienced and qualified cosmetic surgeons, particularly specialists who do a lot of eye and face rejuvenation procedures, and come up with a plan that you feel will work for you.

I hope that was helpful and I wish you the best of luck!

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Amiya Prasad, MD
New York Oculoplastic Surgeon
4.3 out of 5 stars 61 reviews

Restylane for lower eyes

Restylane and laser contouring such as Fraxel or eMatrix combined will help a great deal to correct the situation.  Please consult an expert with these injections. Best, Dr. Green

Fillers are very important but resurfacing of the skin combined with Neuromodulators are very important as well.

I believe you need to have two to three vials of fillers put under the lower eyelids. You also need to have neuromodulators ( Botox, and Dysport) injected in the crows fits as well as right under the eyelids. You also, need to have resurfacing laser treatment. 

How to treat lower eyes

Personally I would recommend a radiofrequency treatment like InMode Fractora under the eyes, and then a good filler like Voluma to the upper cheek area. I think the combination of the two would be great for you, with minimal downtime.

"This answer has been solicited without seeing this patient and cannot be held as true medical advice, but only opinion. Seek in-person treatment with a trained medical professional for appropriate care."

Restylane filler for tear trough instead of surgery

In your case, a tear trough filler such as restylane may greatly improve the deep tear trough that you have and even some of the darkness (often a shadow effect). I'd definitely recommend a filler first with a highly trained expert such as a dermatologist as it is safe and long lasting in this area (often over 1 year).

Benjamin Barankin, MD
Toronto Dermatologic Surgeon
4.9 out of 5 stars 44 reviews

Injectable Fillers

If your main concern is hollowness in the tear trough region injectable fillers can help improve volume. I would recommend to seek an experienced plastic surgeon who does a high volume of injectable treatments to make sure you are a good candidate.

Dr. Daniel Ritacca

Daniel J. Ritacca, MD
Chicago Oculoplastic Surgeon
4.3 out of 5 stars 18 reviews

How to look better at 47 years old

Thank you for sharing your question and posting your photos. You could look refreshed and younger with a conservative blepharoplasty of the upper eyelids, Botox injections in the crow's feet and filler injections in the tear troughs. Make sure an experienced surgeon performs all these procedures. Good luck.

Restylane for the tear trough area vs surgery

Restylane and other hyaluronic acid fillers are a great option to reverse the sunken look under the eyes; this leads to a brighter and  appearance and a less fatigued look.  These fillers however have little effect on the eyelid skin itself and the superficial wrinkles.  Often a combination of fillers with resurfacing lasers will yield great results for both the volume loss and wrinkles.  Eyelid surgery generally addresses fat bulging under the eye an the laxity of the tissue of the lid.   The result is tighter skin and less wrinkling.  It is important to weight the pro's and cons of both options such as risks and downtime when considering which is best for you.

Kyle Coleman, MD
New Orleans Dermatologic Surgeon
5.0 out of 5 stars 8 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.