This post may contain affiliate links that support the site at no cost to you. 

The appearance of your lower eyelids plays a major role in how youthful and refreshed you look. If you’re struggling with undereye bags, dark circles, or excess skin, you may be considering treatment options like blepharoplasty or fillers. Understanding these procedures and their effects is the best way to make an informed decision.

A girl and her dark circles

For me: I’m 38 at the time of writing this post, and I’m starting to do research on this. I have hereditary dark circles and always have. (There’s a picture of me at my fourth grade graduation picnic where I look like I’m coming off a three-week bender. If’ I’m 38, my dark circles are 35.) 

My dark circles have always been purple, with a slight bumpy texture. My skin is both fair and thin. Now that I’m getting older, my dark circles are taking on a life of their own. They have much more creasing, and they extend further down my face. 

Microneedling has done a lot for my skin in the last few years from an anti-aging perspective! I feel like I’ve dramatically improved my skin texture and some slight jowling that I was beginning to see. The dark circles have also firmed back up somewhat…but they’re still dark circles!

And you can’t microneedle your eyes!

I don’t think I’m going to move on a bleph or fillers this year, or probably even before I turn 40. But I’m starting to think about my longer-term plan for aging gracefully. 

What Are Blepharoplasty and Fillers?

Blepharoplasty, or eyelid surgery, is a surgical procedure to address loose skin, fat pads, or hollow areas. It’s a permanent solution that can offer longer-lasting results for the appearance of under-eye bags and wrinkles.

You can approach this in different ways: there’s 

• a lower bleph, which only snugs up the skin around the lower eyelid,
• an upper bleph, which does the same around the skin of the upper eyelid
• Or a “regular” blepharoplasty, where they do the upper and lower. 

This post is specifically about a lower bleph, but it’s worth knowing that you can do above and below at once! For me: I am seeing some looseness in my upper eyelids, so I may well wait and do both at once, even if it means waiting a few more years. That seems easier and cheaper to me than going under the knife twice. 

Fillers, on the other hand, are a non-surgical approach using injectable treatments like hyaluronic acid fillers to improve volume loss in the under-eye area. This temporary solution reduces the appearance of dark circles and fine lines. They’ll address looseness in the skin that is caused by volume loss, but they’ll have a limited effect on age-related sagging. 

Key Differences Between Blepharoplasty vs Fillers

Choosing between these cosmetic procedures depends on your specific concerns, such as undereye bags, hollow areas, or dark circles.

• Blepharoplasty: addresses structural issues like loose skin or fat pads. It’s ideal for those seeking a permanent solution. For older patients, a blepharoplasty may be more cost-effective and yield more significant results.
• Fillers:  effective for mild volume loss or dark circles caused by shadowing. They provide a natural look but require maintenance. For younger patients who might have less facial volume naturally, fillers will create that volume. Without volume, a bleph will just stretch the skin more tightly over the lack of volume. 

A few cautions about tear trough fillers

First: did you see that TikTok (everybody’s seen that TikTok) where they did an MRI of someone’s face of fillers and found that they actually did not dissolve? 

You gotta bring some caution to fillers. They are definitely cheaper than a blepharoplasty, but if they’re not done well, they can migrate. For undereye fillers specifically, if they migrate downward, your undereye circles can end up looking worse!

The area that tear trough fillers go in can also be risky. There are nerves that run through the undereye that your vision relies on, and there are cases of blindness after tear trough fillers! So you need to be sure that you’re seeing a highly qualified injector, even if it means waiting to save up more money. 

This is not the type of filler to pick the cheapest medspa! Basically, you’re not bargain shopping either way, blepharoplasty vs fillers.

When Is Blepharoplasty the Best Option?

Lower blepharoplasty surgery may be the right choice if you have excess skin, fat bags, or a hollow area in your lower eyelids. This procedure removes or repositions fatty tissue to improve the under-eye region.

Patients looking for permanent results and willing to undergo recovery time often benefit most. It’s important to consult an oculofacial plastic surgeon with ample experience for optimal results.

When Are Fillers the Better Choice?

If you’re concerned about fine lines, dark undereye circles, or mild eye puffiness, fillers may be a better fit. Injectable fillers, like hyaluronic acid fillers, hydrate and plump the treated area. This reduces shadowing and creates a smoother, more youthful appearance.

Fillers are a popular option for younger people or those seeking a quick fix with minimal downtime.

While they’re cheaper to start, fillers should be redone regularly. It’s kind of not clear whether fillers actually dissolve in the time frame they say! But all marketing materials for different filler types will say that you should plan for them to last 1.5-2 years. So if you’re looking for something you can afford and you’re okay with needing to pay more later, filler can be a good choice. 

If you are younger or have always had hollowness, fillers may create a structural base that reduces dark circles. 

Important Factors to Consider

Recovery Time for Blepharoplasty vs Fillers

Blepharoplasty requires time off from daily activities, while fillers allow you to return to normal activities quickly. I am (obviously) not a doctor! But I have read every before and after post in every subreddit that discusses blepharoplasty! 

(Look at this blepharoplasty before and after!! The subreddits are literally full of them.)

Most people need 1-2 weeks of true downtime and rest (remember, these are your eyes!!). By four weeks out, most people are looking nearly normal. There will be some mild swelling for some time. As cosmetic surgeries go, this is a relatively short downtime! 

For fillers: there’s no true downtime. Tear trough fillers are very prone to bruising, so this is probably not a filler you want to get right before a big event! But compared to a bleph,  it’s practically a lunchtime procedure. 

How long does a blepharoplasty last? How long does filler last?

Blepharoplasty offers permanent results! That means that the skin will not return to its previous shape or texture, and it won’t fade. However, as you age, your skin will continue to age too! So it’s more like turning back the clock than stopping the clock completely. 

For fillers: marketing materials will say that dermal fillers last 1-2 years, depending on the type of filler. Some recent evidence indicates that that may not be so! A concern with fillers is migration: that the filler can slide down in your face. This is particularly common in tear trough fillers! But it’s not inevitable–it just needs to be placed on your orbital bone. It’s important for this filler, of all fillers, that you go to an expert injector. 

Which is riskier, blepharoplasty vs fillers?

Both treatments have potential risks, such as mild swelling, bruising, or, in rare cases, complications.

You don’t have to have anaesthesia or be sedated for a blepharoplasty. That removes a lot of the risks that might come along with a more invasive surgery! Local sedation is safer overall. You can still get put to sleep for the surgery if you need, but it’s not what’s typically done and you may need to be sure you pick a surgeon who will do it. 

For tear trough fillers, the primary concern is making sure that you’re going to an experienced injector who will avoid the nerves around your eyes. Vascular occlusion is the big worry with most fillers – I wrote about vascular occlusion in lip fillers here.

​

Combination Treatments for Optimal Results

In some cases, combining treatments provides effective results. For instance, using dermal filler injections to enhance collagen production after a blepharoplasty can smooth the delicate skin of the lower eyelids. 

I may end up doing this! Because I always had that hollowness under my eyes, it might make sense for me to add some volume back with fillers in addition to a bleph. Like, going back to where my eyes were at 25 would be great, but I was insecure about the circles then too!

The very best you can afford

This is not a Groupon type treatment! Going to an oculofacial plastic surgeon or a cosmetic treatment specialist who knows what they’re doing is VITAL here. They will assess your facial anatomy and recommend effective treatments tailored to your needs.

As my mother used to say, “You only get two eyes”. Your eyes and your vision are so important that you absolutely should not get a cheaper treatment from someone who doesn’t specialize in the eye area.

And a bleph is not wildly expensive — many reddit surgery reports say they paid $4000-6000, depending on area. Compared to a rhinoplasty, that’s a fraction of the cost. It’s better to wait a little longer and get the best than scrimp and potentially sacrifice your vision.

Final Thoughts

Thanks for coming on this tour of my insecurities!

No, but really: I never saw myself as a plastic surgery type of girl. But as I get older, I’m seriously considering the bleph. I guess my definition of aging gracefully is changing as I actually, um, age. (And maybe this urge will pass! I am honestly not sure.)

Whether you opt for lower blepharoplasty procedures or undereye fillers, or just embrace aging, your choice should boost your confidence! And as I keep looking at my options, blepharoplasty vs fillers, I’m going to stick to trying to find what makes me feel most like myself.