What Treatment Would I Benefit from the Most; Tear Trough Filler; Laser Treatment or Lower Blasphoplasty? (photo)

I am really self concious about the underneath of my eyes. I always look tired and haggard. I always get people asking if i had a late night or telling me i look rough. Im only 26 and have had this problem since a teenager but it just seems to be getting worse! So i have recently looked into cosmetic surgery and have booked a consultation in a few weeks time. I was just wondering if after looking at my picture anybody could help me on here...?? Really need some advise?? Thankyou

Doctor Answers 5

Under eyes making u look tired....


On quick examination of your photo, you have fat prolapsing and volume loss in your tear trough and cheek area.

Your options include filling the tear trough area with fillers, either temporary or with fat (my preference). Other options include conservative transconjunctival blepharoplasty to remove some of the fat pockets under the eyes, or laser resurfacing of the lower eyelids.

Discuss these options with your plastic surgeon as it varys depending on your physical exam. 




New York Facial Plastic Surgeon
4.9 out of 5 stars 89 reviews

First get a longer focal length lens.

The short focal length lens distort the face and make you look much worse than you really are.  From your photos, you definitely have options.  You will benefit from an arcs marginalis release transconjunctival lower eyelid surgery.  Alternatively, you could have very nice benefit with deep mid face fill to address your V-deformity below the lower eyelids.  I generally use Restylane or Perlane for this purpose.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Filler vs fat

As mentioned before, volume is the key here. Adding filler or fat to the hollowness between the cheek and eyelid will improve that appearance.

Fillers are a bit safer with less risk of lumpiness [it can be easily removed] but are not long lasting [up to a year].

Fat is permanent, but technique is incredible important as lumpiness is more difficult to deal with.

Fillers are also less expensive in the short term, and probably the way to start for you.

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 37 reviews

Filling the Tear Trough Works Best For Tired Looking Eyes

All of the options you mentioned are possibilities, but from the photo it appears that your best option would be to add back volume. Filler into the tear troughs would camouflage the puffiness underneath your eyes, smooth the tired look, and re-connect your cheeks with your lower eyelids. By re-connecting the cheeks to the lower eyelids, the eyelids would look shorter, which has a younger, less tired appearance on it's own. I would use Restylane for the tear troughs (smooth, lower volume, stable result). It also appears as if a higher volume filler (like Radiesse) to your cheeks (below the tear troughs) would help fill out the area as well, giving a refreshed look to the entire mid-portion of the face.

Michael R. Menachof, MD
Greenwood Village Facial Plastic Surgeon
4.4 out of 5 stars 26 reviews

Lower Lid Rejuvenation



Although you have some lower lid fat prolapse, you also have a relative lack of volume in your cheeks.  Before making a formal recommendation, I would need to examine you.  However, given your photo and your age, I think you are a good candidate for filler injection into your tear troughs.  This procedure is quick, low risk, and reversible.  I fear that lower lid fat removal would make you look skeletonized.  Another option could be lower lid fat repositioning to the tear trough.

Michael McCracken, MD
Lone Tree Oculoplastic Surgeon
5.0 out of 5 stars 12 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.