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  • Chris Thiagarajah MD

Lower Eyelids: Surgery, Filler, Laser, Bleaching…which ones are the best in 2017?



​​Often my patients in Denver want to know what the best options for their lower eyelids are. I have created a system to guide patients what the best treatments are for improvement of the appearance of the lower eyelids.

First I’ll make a list of all the problems that patients complain about in their lower eyelids

Lower eyelid bags

Lower eyelid hollows

Dark Circles

Wrinkles under eye

Wrinkles to the sides of the eye (Crow’s feet)

This is a description of each problem that patient’s complain about



Lower Eyelid Bags – This is puffiness of the lower eyelid caused from fat from behind the eye. In the morning, the fat fills with water and is more pronounced. In the evenings it tends to get better. The lower eyelid bags are more common with time but can also be associated with some medical conditions such as Graves disease or trauma.

Sometimes the lower eyelid bags are subtle and are even combined with hollowing of the lower eyelid. In this picture one can see how both the left (patient's left) lower eyelid bag and hollow make the appearance under the eyelid worse.



Lower Eyelid Hollows – These are the hollow areas under the eyes. This line is caused by aging and genetics and gets worse with time. Many times the hollows under the eyes are magnified with lower eyelid bags and the two magnify each other.

Young patients can notice lower eyelid hollows in their 20s


Lower eyelid hollows can be even seen in male and female patients alike

Dark Circles – This are the dark circles that some patients have under their eyes. These are most commonly caused by pooling of blood and discoloration of the the skin. These can be inherited and are commonly seen in family members.


Wrinkles under the eye – This is often caused by excess skin of the lower eyelid that develops with aging. Often, these wrinkles are worse when a patient is smiling.


Wrinkles to the sides of the eye - These wrinkles are commonly seen when a patient smiles and are referred to as Crow’s feet

Festoons - These are bags or areas of swelling that are actually below the lower eyelid. They are located on the cheek. This is a complicated topic and best left for a different article since this is really part of the cheek

Next I'll make is a list of the different cosmetic treatments that can be performed on the lower eyelid and what each is good to bad at.

Lower Eyelid Blepharoplasty (Fat Removal)

Lower Eyelid Blepharoplasty (Fat and Skin removal)

Laser to lower eyelids

Bleaching creams

Botox

Cauterization of tissue

Lower eyelid blepharoplasty (Fat only) - In this procedure, fat is removed from the eyelid alone to improve puffiness. It is great for puffiness of the lower eyelid. It does not help with wrinkles or discoloration of the skin or lower eyelid hollows.

Lower Eyelid Blepharoplasty (Fat and Skin removal) This procedure is great for fat and skin. Less fat is removed if the skin wrinkling is the big problem to tighten the skin.

Laser to lower eyelids This procedure is for lower eyelid wrinkles and discoloration of the eyelids. It does nothing for puffiness or hollows.

Bleaching creams/Cover-up - As can be imagined this is best for discoloration of the skin.

Botox - Botox temporarily paralyzes muscles and worse best for crows feet and under eye wrinkles if they are mild.

Cauterization of tissue - This is best for under eye wrinkles and festoons. In this procedure, tissue under the skin is shrunk via a burning device. This happens often in any surgical procedure.

Here is a summary of the treatments for cosmetic improvement of the lower eyelid. Remember, this is a general simplification of the treatment of lower eyelid cosmetic problems. Each person is different and there is definitely not a cookbook standardized treatment for every patient. Many patients need a variation of the guide. That being said, this is a good general guideline for patient to use and research when they are getting a consultation. Oculoplastic surgeons are eyelid specialists who have a myriad of tools to help patients look their best on their face and especially around their eyes.



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