Blepharoplasty or Fillers for under-eye circles?

I am 50 years old and have some facial fat loss and sagging of the skin. Most significant are the dark circles under my eyes. I have slight drooping of the upper lid and deep glabellar lines. One consult recommended fillers for under the eye and in cheekbones and another recommended surgery (and said the fillers wouldn't eliminate the dark circles). Both said that Botox (or similar) could be done at the same time as either procedure. Any advice for me?? (Note: I am getting married in 7 weeks. Not expecting full results by then but, sure don't want to look obviously post-procedure!).

For facial fat loss, I believe the best correction is to refill the areas where you have lost the fat. This can be done with either off the shelf fillers (I prefer Juvederm Voluma but Radiesse also works) or your own fat. This is especially true for someone your age in whom I can almost always correct the problem with fillers unless there are other problems. An exam would be necessary to determine what you need for the upper lids. Perhaps only an upper blepharoplasty (with no fat removal) with resection of the glabella muscles and a lateral brow tack or, maybe, a brow lift instead. You will need the "deep" glabella lines filled, but, hopefully, only this time or once or twice more since the muscle causing the lines would be gone.

Robert T. Buchanan MD
Robert T. Buchanan MD
209 Hospital DrHighlandsNC28741US

Robert T. Buchanan MD

209 Hospital Drive, Suite 202, Highlands,
NC, 28741, US

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I will start with your conclusion. Seven weeks is too little time to schedule appropriate surgery and recovery when you're having a wedding (and my congratulations to you). At this point, injectable fillers and neuromodulators such as Botox would be useful for the right indications. Botox for glabellar creases is an excellent initial step and does not need to be done during a surgery procedure. Proper use of Botox beneath the lateral eyebrow can give a slight elevation of the lateral brow. Under-eye grooves may be an indication for hyaluronic fillers such as Restylane which can be used with care, but not if the primary problem is protruding fat pads. If experienced plastic surgeons recommend blepharoplasty, then you will probably want to schedule it sometime after your wedding. I usually recommend lower lid surgery heal well before HA filler is placed, but other surgeons may recommend another approach. Best wishes.

Sutton L. Graham II, MD, FACS
Sutton L. Graham II, MD, FACS
615 Halton RdGreenvilleSC29607US

Sutton L. Graham II, MD, FACS

615 Halton Road, Suite 100, Greenville, SC,
29607-3403, US

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I is obviously hard to make an assessment without photos. But guessing from the fat you have "facial fat loss and sagging skin", I think a lower lids may be indicated. However, even after that procedure you may need fillers (or fat grafting) to help eliminate the dark circles. Botox definitely works for the glabellar area and crows feet. With the time restriction of 7 weeks, though, surgery may no longer be an option.

Dr. Luong

Jacqueline A. Luong MD
Jacqueline A. Luong MD
6545 France Ave SEdinaMN55435US

Jacqueline A. Luong MD

6545 France Avenue S., Suite 350, Edina, MN,
55435, US

There are several possible causes for dark circles under the eyes so a definitive answer would require a physical exam. Shadows from contour depressions in the tear trough can be eliminated with fillers or blepharoplasty. Venous congestion or muscle edema may respond to laser treatments. Surgical correction may require a month or two to see final results so your timeline may be more amenable to nonsurgical refinement for now with more definitive correction down the road.

Clark F Schierle MD, PhD
Clark F Schierle MD, PhD
676 N St Clair StChicagoIL60611US

Clark F Schierle MD, PhD

676 N Saint Clair St #1575, Chicago, IL,
60611, USA

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The discoloration cannot be eliminated with fillers or toxins. Volume can be added to desired areas and the glabellar and crows feet treated with toxin. Upper lid eyelid excision should be to performed Best of luck.

Robert Whitfield MD, FACS
Robert Whitfield MD, FACS
1510 W 34th StAustinTX78703US

Robert Whitfield MD, FACS

1510 W. 34th Street, Suite 100, Austin, TX,
78703, US

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