Told filler under my eyes would make the bags look worse. Is a lower bleph really the only option?

Trying to get my head round conflicting advice and I would really value hearing from people who have actually stood at this fork.

I have had shadowy, puffy under-eyes since my mid thirties. Went to an aesthetic clinic first because surgery frightened me, and the practitioner was keen to fill the hollow along the bottom of the eye socket. Then a friend sent me to a surgeon for a second opinion and he looked at me for about thirty seconds and said filler would probably make me look puffier, not better, because the problem is the bulge sitting above the hollow rather than the hollow itself. He said the honest options were leaving it alone or a lower blepharoplasty.

So which is it. Two people who both do this for a living looked at the same face and said opposite things. Is the surgeon just steering me towards the more expensive thing he happens to sell? And if the bulge really is fat, is there genuinely nothing short of surgery that shifts it?

Not the same, and the giveaway is which one of them touched your face. Thirty seconds sounds dismissive but if he pressed along the rim and watched what moved, that is the whole assessment right there.

I went the filler route first, so here is my cautionary tale. Mine did look better for about four months in flat lighting and noticeably worse in strong overhead light, sort of shiny and full in a way that did not read as rested. Turned out I had a real fat bulge and we had padded the ditch underneath it instead of dealing with the ridge above. Ended up having it dissolved. Not a disaster and I do not regret trying the reversible thing first, but I would not repeat it now that I understand what was actually going on.

Also worth saying: the aesthetic clinic never once mentioned the option of doing nothing. The surgeon did.

kept_blinking said:

Is the surgeon just steering me towards the more expensive thing he happens to sell?

Fair question but flip it round. The injector also sells the thing the injector recommended, and sells it repeatedly, every year or so, forever. Neither of them is neutral. What makes one of them more trustworthy is whether they showed you the reasoning on your own face.

I sat exactly where you are, and I went and had the non-surgical consultation first for the same reason you did, because surgery near my eyes terrified me.

What eventually made it click for me was understanding that the two treatments are aimed at different things. Filler adds volume into a hollow. Lower eyelid surgery deals with fat that has pushed forward and, in a lot of modern practice, drapes that fat over the rim to soften the hollow rather than simply removing it. So if your main complaint is a genuine bulge, filling the dip below it can make the whole area look fuller without making the ridge any less obvious, which is what happened to hoodedat52 above. Where I ended up is that neither treatment is better in the abstract, they are answers to different questions, and the only useful thing is which question your face is asking. Our write-ups on tear troughs and fat repositioning and on eyelid surgery versus the non-surgical options walk through where each one genuinely helps and where it does not.

The one thing I would push back on gently is the framing of doing nothing as failure. I lived with mine for another eighteen months after that first consultation and used the time to read, to get a second surgical opinion, and to be certain. Nothing about this is urgent.

That is a helpful way to put it, thank you. I think what threw me is that I walked in assuming there was one right answer and I just had to find the honest person who knew it.

Going to book a third opinion, with an oculoplastic surgeon this time, and specifically ask them to show me in a mirror what is bulge and what is hollow. Will report back. Still not remotely ready to book anything.

Update, three months later, and it is an unsatisfying one so I apologise in advance.

Third opinion said the same as the second: mostly fat, a bit of hollow, filler alone would not do it. She also said my lower lids are on the lax side, which apparently makes the external approach riskier for me, and she would want to do something to support the lid at the same time if I went ahead. That has slowed me right down. I am not saying no, but a straightforward eye bag removal has turned into a longer conversation than I expected, and right now I am living with it and thinking. Two of the three people I saw were completely right and I still have not booked a thing.