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Raval Facial Aesthetics Blog

Surgical versus Non-Surgical Lower Eyelid Treatments

Posted by Amy Raval on Mar 13, 2018, 10:00:00 AM

lower eyelid treatmentsPuffy, wrinkly or droopy lower eyelids can make you look older than your age, or chronically tired. Nobody wants that. Fortunately, we can correct these symptoms, often without surgery. There are treatments for upper eyelids, too, and these can be performed at the same time or separately from lower eyelid treatments. In this article we’ll focus on your under-eye options.

Cost and downtime are far lower for non-surgical treatments, and often you can still achieve the results you want – firmer, smoother, more youthful looking eyes. But should you have surgery after all?

What causes these problems?

It’s not necessarily a lack of sleep. Genetics make some people more likely to develop puffiness and grooves under their eyes. Usually, though, it is age-related.

As we get older we lose facial fat, which causes our cheeks to appear flatter and our skin to sag. The fat along our upper cheeks tends to break down faster than the fatty tissue immediately under our eyes. The “bags” we see are pockets of fat that now bulge because they are no longer supported by our cheeks. The skin that forms our lower eyelid can also weaken with age, making it easier for fat to protrude.

Non-surgical options

Here at Raval Facial Aesthetics, we use either dermal fillers or PRFM to treat lower eyelid issues, depending on each patient’s specific concerns. Dermal fillers replenish lost volume, erasing or reducing the appearance of wrinkles or grooves under the eyes. When puffiness is mild to moderate, smoothing the grooves may be all that is needed to dramatically improve appearance.  

Sometimes dermal filler is also used to replace volume in the upper cheek area. This helps reposition protruding fat so it no longer forms bags. It also offers a beneficial side effect of giving your cheeks a more youthful appearance, too.

If you have dark circles under your eyes, Dr. Raval may recommend PRFM treatment instead of, or in addition to, a dermal filler. A laser peel can also help alleviate dark circles, and for patients with mild to moderate excess lower eyelid skin, laser peel may be a good alternative to surgery.   

Non-surgical options are popular with patients because they are fast and require no downtime.

When is surgery indicated (or not)?

Especially if you’re in your 30s or 40s, dermal fillers are almost always the best choice. But for some people, surgery (called blepharoplasty) is the better option. In a lower blepharoplasty, Dr. Raval will surgically remove excess fat, or relocate the fatty tissue so it fills in grooves that have appeared. He recommends this procedure only in certain circumstances:  

  • You have severe puffiness, but not excess skin,
  • You have naturally flat cheekbones, so adding filler would look unnatural.

Dr. Raval recommends against lower eyelid surgery if:

  • You suffer from dry eyes, because surgery can exacerbate this. Dr. Raval suggests discussing this first with your ophthalmologist.
  • You have had previous eyelid surgery, because the risks are always greater with revision surgeries.
  • You have lid laxity. You will need a different surgical procedure to tighten the muscle and lid before any cosmetic surgery.

Every surgery Dr. Raval performs is tailored specifically for that patient. So he often uses fillers in addition surgery to achieve the best, most natural-looking results.

Which is best for you?  

Ultimately, it’s up to you whether you want surgery or a non-surgical treatment. During a personal consultation, you can discuss your concerns and ask questions. Dr. Raval will examine your face to determine what’s causing your lower eyelid problems, then recommend the most effective option treatment plan for you.


There is no reason to continue looking fatigued and older than you are. With the right lower eyelid treatment, your eyes can help your entire face look younger and refreshed.

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Topics: Non-Surgical Procedures, Denver Facial Plastic Surgeon, Eyelid Procedures