Surgical Decision-Making for Under-Eye Aging: When to Use Surgery Instead of Fillers

Conclusions

• The presentation concludes that fillers are useful for carefully selected patients, but they have clear limits and should not be used when structural aging changes are the main problem.
• It argues that surgery is preferred when fat prolapse, festoons, lower lid laxity, or midface descent are present because these problems require repositioning and tightening rather than added volume.
• The speaker’s central claim is that lower eyelid hollowing and bulging often reflect misplaced fat, so surgery can treat both the bag and the hollow more definitively than filler.
• The presentation concludes that patients whose swelling worsens through the day, or who have festoons or malar mounds, are poor filler candidates and should generally be steered away from injection.
• It emphasizes that filler does not correct septal attenuation, bone recession, ligament laxity, or excess tissue, while surgery can address all of these anatomic changes.
• The talk concludes that a careful clinical examination and phenotyping of the anatomy should guide treatment choice more than a one-size-fits-all preference for injectables.
• It suggests that surgical correction can provide longer-lasting results, often 10 to 15 years, and may be more cost-effective than repeated filler maintenance over time.
• Overall, the presentation arrives at the conclusion that recognizing when to stop injecting and proceed to surgery is essential for better outcomes in infraorbital rejuvenation.