Laser vs. Lower Blepharoplasty for under eye hollows (49 years)? (photos)

I'd
like to reframe your question so that it asks, "What is the best approach
in my specific situation?" Rarely is an either/or answer correct when
considering facial rejuvenation. The surgeons you consulted had the advantage
of a physical examination of your skin, and that is always better than
judgments based on photos. However, I believe you may benefit from a
combination of lower eyelid surgery and laser resurfacing, or a laser treatment
combined with fillers such as Restylane or fat grafting. Obviously, surgery is
a more invasive approach, but it offers more extensive, lasting results. The
right choice for you depends on your own priorities. Good luck with your decision.

Thank you for your inquiry. It is difficult to say with certainty based on photographs what your best option is. I would consult with a surgeon who is highly experienced in both surgical and nonsurgical techniques including technology-based approaches and injectables to determine your best options. Frequently a combination of treatments is required to achieve best outcomes for lower eyelid rejuvenation.

Hello there- you bring up a very good question at the heart of the lower lid rejuvenation debate. The debate includes issues such as Fillers vs surgery and laser vs fat transfer. It would be very helpful if you posted this question with photos showing your face in repose. Smiling hides many of the lower eyelid – cheek aging changes. The current photos demonstrate skin aging changes and probably some more eyelid – cheek interface volume loss. Without being able to see your face with muscles relaxed, it is difficult to make definitive suggestions. As a rule of thumb, if you are unsure of how to proceed, you should proceed with the least invasive option. Fillers are reversible and allow you to "try on" volume rejuvenation before proceeding with anything definitive. I hope this is helpful – good luck. Many of us would be able to give you more information with more photos.

If you are unhappy with some hollowness, then IMO, fillers conservatively placed may be the solution. If you have loose skin or herniated fat, then surgery would be good.  A combo of both may be necessary.

barnold1872, as is frequent on these Internet boards no one should or can answer this question based on your photos only. You are smiling and your angles are incorrect both of which affect the lower lid considerably. In general for tear trough and aging of the lower lid I recommend a "SOOF lift blepharoplasty" which includes resurfacing of the lower lid. You can research this on the Internet. It is a safe very effective procedure but you need to find a surgeon familiar with the procedure. Good luck!

Most expert
experienced artistic plastic surgeons have a variety of procedures, both
non-surgical and surgical, at their disposal to produce excellent cosmetic
results in the appropriately selected patient: neurotoxins (Botox or Dysport),
temporary fillers like Restylane, long lasting micro-fat grafts,
blepharoplasties, and combinations of procedures. There is no one best
procedure. Each has benefits and drawbacks and depends on desired outcome and
individual anatomy.
In a patient your age and with your particular anatomy, a temporary hyaluronic filler like Restylane in
addition to Botox or Dysport would be a reasonable place to start.
Following the advice of anyone who would presume to tell you what to do without
seeing photos and without taking a full medical history, examining you, feeling
and assessing your tissue tone, discussing your desired outcome and fully
informing you about the pros and cons of each option would not be in your best
interest. Find a plastic surgeon that you are comfortable with and one that you
trust and listen to his or her advice. The surgeon should be certified by the
American Board of Plastic Surgery and ideally a member of the American Society
for Aesthetic Plastic Surgery (ASAPS). You should discuss your concerns with
that surgeon in person.
Robert Singer, MD FACS
La Jolla, California

Dear BArnoldThere is no specific single answer to your issue regarding the hollows and laxity of the lower eyelid skin.This is due to your needs and preferences as well as the skill of your plastic surgeon.  For this reason it is important for you to seek consultation from someone that has the ability and experience  to do a variety of procedures well.This person then should review with you all of the options available as well as the advantages and disadvantages of each.It is then possible in many instances even stage the procedures doing first one and then according to your needs utilize other options.  Many times the results of various procedures while overlapping are not identical and address specific needs.  Example would be laser which would tighten the skin and filler which would decrease the hollows.  If there is any question as to regarding the recommendations then you should seek a second opinion.  Be certain to ask a lot of questions.Dr Richard Gregory

I think fillers are a great option in the appropriate patient, and I think the same of surgery. It all depends on what the patient's goals are and what is surgically feasible.Several factors can contribute to an aged/tired appearance of the lower eyelid -- descent of the cheek fat, prolapse of the fat around the eye, excess skin, etc. Based on your photos, it appears that skin excess is part of the problem, as well as a lack of volume at the lower eyelid/cheek junction.As the fat of the cheek descends it can leave the bony rim of the eye socket more apparent through the relatively thin skin of the lower eyelid, and cause deflation and abnormal shadowing that makes you appear older or tired. In most this occurs with age but it can be genetic (the so-called "negative vector" cheek).Excess skin in the lower eyelid can cause "crepey" wrinkling.  Additionally the thin skin of the lower lid is somewhat translucent to the muscle underneath it, and that's why it appears like dark circles (imagine placing a wet paper towel on a raw steak -- you'd be able to see the darkness of the muscle through the thin paper towel).I have had great success with dermal filler in the lower eyelid -- see my profile page photos for examples. Injectable dermal fillers are expensive and temporary but safe. In the lower lid the procedure is technician-dependent so find someone reputable. You can try this approach to see how you like the result, but repeated injections would have to be performed every 9-24 months thereafter so you may wish to consider a technique that lasts longer. Fillers add volume, but do not correct the skin excess, so the crepey wrinkling will persist to some degree.
You could consider autologous fat transfer to the problem area. Fat transfer is safe and can be performed under local anesthesia with oral sedation. My chief concern would be potential irregularities of the contour of the skin afterward, and a potential temporary result.
The most definitive correction is surgery. Through an incision just below the eyelashes, the fat of the upper cheek may be mobilized and sutured into a higher position to add volume to the lower eyelid and help the dark circles fade. Though it should not be considered a permanent solution, this approach should give you a durable improvement over 15 years or more (before you start to see the same issues appear again). Surgery addresses both the fine crepey wrinkles and volume loss. You can see photos of patients who had this procedure on my profile page.It sounds like you should seek out a third opinion. As always, obtain a consultation with a Board-certified Facial Plastic Surgeon, Oculoplastic Surgeon or General Plastic surgeon (who has experience with blepharoplasty) to get a fully-informed recommendation from a surgeon who is able to examine you.Best wishes! Harry V. Wright MD, Sarasota, Florida

I TOTALLY disagree! Try under eye tear trough fillers FIRST! Like Restylane Silk or Belotero-Balance!