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Filler Choices for ‘Baggy’ Eyelids

Posted: 6:00 a.m. Sunday, Nov. 26, 2017

By Anita Mandal, M.D.
Question: I have bags under my eyes, making me look tired. Is there a filler that can help me look more rejuvenated and less tired?

Answer: There are several effective fillers that exist. However, what’s most important is making a correct diagnosis to identify the true cause of under eye “bags.”

Many patients are concerned about lower lid bags when, in fact, they have hollowing with volume loss under the eyes. In such cases, injectable fillers may help. Restylane can be used to fill under eye hollows, but works best when the hollowing is limited to the inner half of the lower lid. When Restylane is placed in the outer part of the lower lid hollows, it can be more prone to lumpiness.

For hollowing throughout the entire lower lid, I find Bellafill to be the most suitable choice since it can fill the inner, central and outer lower lid hollows, giving a more natural looking appearance to the entire lower lid region.

In patients with true fat bags under the eyes, they can be surgically removed with a procedure called blepharoplasty. However, in some cases, removing fat bags can make the lower lid hollows worse, requiring filler treatment. In others, bulging fat under the eyes can be softened non-surgically by placing filler in the hollows under the bags without the need for surgery. The combination approach of surgery with injectable filler is only used under certain circumstances, based on each patient’s unique aging anatomy.

Some patients mistake the malar crease for a lower lid hollow. Malar creases form as a depression in the upper cheek as a result of an aging malar ligament which attaches the cheek skin to the underlying malar or cheek bone. Attempts to treat the malar crease depression as a lower lid hollow can lead to failed results. Malar creases are addressed by filling the cheek area in a specific pattern quite different from that used for lower lid hollow treatments.

Another important consideration is a patient history of intermittent swelling of the lower lid/cheek area. This swelling can occur from an aging lymphatic system, diet and other factors. HA fillers such as Restylane or Juvederm which work by attracting water into the treated tissues can worsen this problem. Bellafill, the 5-year filler, which works by stimulating your body’s own collagen, can be a more suitable choice in this scenario. However, it is important to realize that fillers, by themselves, don’t typically cause intermittent lower eyelid swelling. A patient typically has a predisposition to intermittent swelling prior to filler treatment and should inform their doctor of this condition in advance of treatment.

Careful consultation by a Board Certified Facial Plastic Surgeon who understands the intricate anatomy of facial aging is the first step in helping you to decide your most suitable rejuvenation options.


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