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.

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