Lower Eyelid Surgery or Fillers?

For those “bags” under the eyes or a hollowed-out appearance, patients often wonder whether lower blepharoplasty eyelid surgery at my Fairfield, CT practice is the best option. Others come in wanting to know if injectable fillers can make a noticeable improvement.

Here’s the short answer: Each approach has benefits, but in most cases I recommend eyelid surgery for longer-lasting results.

People often begin thinking about cosmetic treatment for dark circles under the eyes after hearing friends comment over and over again on how tired they look. Shadows under the eyes are often genetic, and some patients as young as 20 contact my office seeking treatment.

Here’s a brief description of how each approach can help minimize these cosmetic concerns:

Dermal Fillers

A conservative approach with fillers such as RADIESSE®, JUVÉDERM®, or Restylane® can plump the tear trough area in a subtle way, softening a hollow appearance. Surgically removing fat (as in a lower blepharoplasty) when a patient is concerned about the lack of volume under the eyes is counterintuitive.

The primary advantage of filler treatments is that there is virtually no downtime following the procedure. The drawback: Treatments won’t provide permanent changes; maintaining the results requires follow-up treatments.

Lower Eyelid Surgery

Today’s eyelid surgery approach involves sculpting and repositioning fat under the eye to get optimal results. I may even add fat in a strategic way to create an appearance that is more youthful and rested.

Lower eyelid surgery using a transconjunctival incision (that is, inside the lower eyelid) eliminates any external scar. When an external incision is the best approach, I make it in the lower eyelid’s natural crease, so it’s still barely perceptible. Lower eyelid surgery minimizes excess skin and can smooth the fine wrinkles that develop with age, in addition to reducing puffiness and dark circles.

The Bottom Line

In either case, correcting aesthetic concerns in the area below the eyes does require a specialist who understands the unique facial anatomy that’s involved. The correct treatment path depends on several factors, including the reason for dark circles or bags to appear. In many patients, thin skin beneath the eyes enables the muscles and blood vessels to be seen more clearly than in other individuals. And, as people age, small pockets of fat can create bulges.

Ultimately, you’ll need to consult with a board-certified plastic surgeon with a track record of excellent results.

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