Bilateral lower eyelid blepharoplasty for under eye hollowness?

Question

I’m a 35 year old female who isn’t happy with my under eye hollowness and eye symmetry due to prolonged use of hydrocortisone cream on lower eyelids. I previously got restylane eye fillers and experienced swelling and had to have them removed. I was then given the option to do a bilateral lower eyelid blepharoplasty. Since I do not have under eye bags, is it noticeable where you move tissue from? Im praying this procedure is my miracle. TIA

Jason Emer, MD · Answer

At home peels like cosmelan, enlighten and aerify along with dermarolling (MTS roller with anteage MD ampules) should be started now. There are many things you can do to treat under eye hollows and dark circles. A surgical option to remove skin and/or fat will such as lower eyelid blepharoplasty with or without fat pad repositioning will be the best long term. There are many things you can do to treat under eye hollows and dark circles without surgery. Non invasive less downtime options such as fillers (Belotero, Juvederm Volbella​), lasers (Moxi/Halo/Fraxel/CO2​), Renuvion (J-Plasma), microneedling/PRP, stem cells and microneedling RF like Fractora PiXel8 or Morpheus can all help give some improvement. Accutite can often be used or stronger lasers like erbium or co2 spot treatment can tighten the skin and give very quick improvement in wrinkles and texture. A surgical option to remove skin and/or fat might be the best solution long-term. I suggest you get a formal consultation to see what is best for you and your goals. Best, Dr. Emer.

C. Blake Perry, MD · Answer

In people who need volume, the fat of the lower eyelids is moved to fill the tear trough. Often additional filler in the cheek and midface can be used in addition to the surgery.

Ayse Dolar Bilge, MD · Answer

Tear trough filler might be better option for you. Blepharoplasty is not seems suitable for you.Best regardsDr Ayse

David K. Isaacs, MD, FACS · Answer

A lower eyelid blepharoplasty will not address undereye hollows if there is no fat to reposition into those hollows.

Some options for volume augmentation of the lower eyelids include filler injections, tear trough implant, and fat grafting.

Most patients opt for filler injections as they are more conservative and predictable.

Many patients I see mention having tried fillers without success, but it's not uncommon for me to dissolve that filler (if not already done) and reinject. Injecting undereye hollows can be challenging in some patients and requires a methodical and thoughtful approach.

I've attached a video on my Undereye Weekend Lift which may give you some insight as to how I approach some undereyes.

Thomas A. Mustoe, MD, FACS · Answer

I agree that you need volume and the best solution is fat transfer with or without release of the partition between cheek fat and eyelid fat (arcus marginalis and orbicularis muscle.  It is now very unusual  to have a reaction to filler. Choose an experienced surgeon and look at before and after pictures.

Kenneth D. Steinsapir, MD · Answer

Restylane is the right treatment. It is normal for it to swell. The swelling increases when the product has been in place for a while, generally  more than a couple of years. If you had a swelling issue before this time frame, likely your problem was bad technique by your injector. These fillers do have a lifecycle. Commonly treatments are topped off annually until the third or fourth year. At that point, there is enough breakdown of product that all the filler should be removed and the cycle started over. All hyaluronic acid fillers breakdown like this over time. Do not get talked into grafted fat. You will instantly regret that decision. The grafted fat is like injecting scar tissue. Unlike hyaluronic acid filler that has a problem, there is no simple means of removing unsatisfactory grafted fat. There is no substitute for a detailed, in person assessment. Your eyes can be your best feature.

Bilateral lower eyelid blepharoplasty for under eye hollowness?

Answers (6)

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