Lower Eyelid Surgery vs Fillers for Eye Bags

Eye bags and dark circles are common aesthetic concerns in our cosmetic surgery office. Whether from genetics, aging, or lifestyle, patients want to treat the lower eyelid area and improve its appearance.

Lower eyelid surgery (blepharoplasty), fat transfer, and filler are the primary cosmetic procedures that can be used to address wrinkles and sagging around the lower eye area. Lower blepharoplasty, also known as eyelid surgery, can be combined with fat transfer for an enhanced effect. Fat transfer can be thought of as a more “permanent filler” that is natural.

Causes of eye bags and dark circles

Eye bags and dark circles develop from multiple factors. Age is one factor, but these may also be present from a young age. From an anatomic perspective, dark under circles and eye bags may be from the following:

  • Excess fat around the eye itself, protruding forward and creating bulges. Plastic surgeons refer to this as pseudoherniated fat.
  • Too little fat in the area beneath or under the eye bags, creating a hollow or sunken area that creates a shadow
  • Insufficient bone volume of the cheeks
  • Loose and wrinkled skin
  • Excess pigment or blood vessels in the skin and tissue


Choosing Lower Eyelid surgery vs. Filler

So you’re tired of looking tired and ready to do something for those bags and dark circles. How does one choose between the options?


Different goals

The aesthetic results of eyelid surgery and fillers are fundamentally different. The goal of lower blepharoplasty is to remove excess skin and fat from the lower eyelids to improve the appearance of under-eye bags, wrinkles, and sagging skin. Filler, on the other hand, is used to add volume and smooth out hollow areas, but it does not address excess skin or fat. Filler temporarily camouflages the appearance of dark circles and eye bags.


While filler can provide immediate results, it is a temporary solution that requires repeated treatments to maintain the desired effect. Results with filler last several months to a year for many patients. Lower blepharoplasty, on the other hand, provides much longer lasting results that can improve the appearance of the lower eyelids for many years.


Downtime after surgery is inherently longer than filler injections. Patients return to work several days after surgery. Filler patients often go back to work the same or next day. Patients who have an event within a few days are more likely to consider filler. On the other hand, patients who have more recovery time may consider lower eyelid surgery and fat transfer.


While filler is generally safe, there are potential risks associated with the injection, including bruising, swelling, allergy, and infection. Lower blepharoplasty is a surgical procedure with risks, but when performed by a board-certified facial plastic surgeon, it is generally considered a safe and effective way to achieve long-lasting results.


The initial cost of lower blepharoplasty is typically higher than the cost of filler. However,  costs of lower blepharoplasty and fat transfer over the long term are usually less. The results of eyelid surgery are long-lasting and can ultimately be more cost-effective than repeated filler treatments over time.


The decision to choose lower blepharoplasty or filler ultimately depends on each person’s goals and preferences, as well as unique anatomical features and medical history. There isn’t a “best plastic surgery”.

Consultation with a board-certified facial plastic surgeon is important. The surgeon can evaluate an individual’s specific anatomy and concerns and then recommend the most appropriate treatment option.

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