Thank you for including excellent photographs. The solution to your problem is actually twofold: The maxillary bone support is somewhat deficient and the "circle " under the eye is prominent due to an adherent ligament which pulls the skin inward. Our best results have been directed at softening the lid-cheek junction by releasing the ligament and mobilizing the existing fat to dampen the sharp visible circle.We also add structural fat grafting which adds support under the eye to compensate for the maxillary bone deficiency.Both of these maneuvers are directed at preventing hollowness, which is critical.
Thank you for your question. Dr. Kahn's comment below on "negative vector" and the need to ensure lower eyelid support is very important. Please make sure your plastic surgeon is board certified and is very familiar with all aspects of blepharoplasties (eyelid surgery).
You do have some contour issues but there are many ways to address them, from surgery to fillers and resurfacing. See a local plastic/oculoplastic surgeon for an evaluation and options on how to best resolve your concerns and choose what is best for you.
There are many different reasons for someone to have the appearance of bags under the eyes. Without being able to examine you from the limited views of your photos it looks like you have what is called a negative vector. Your eye is more prominent that the orbital rim underneath. There can be several ways to address this and many opinions as to what is best. Some options include fat removal, augmenting the orbital rim with filler or implants, or a mid face lift. The key I believe to the operation is to ensure that the lower eyelid has adequate support to avoid it from being displaced downward.
I encourage you to seek several opinions and select the individual that you feel understands the problem as well as your goals for surgery.
- The photos indicate that your problem is excess lower lid fat that can be removed.
- It runs in families,
- Lower lid blepharoplasty to reposition the fat, to trim it or both will help,
- A transconjunctival blepharoplasty avoids any visible scar. Best wishes.
Your are the perfect candidate for lower lid blepharoplasty with fat transposition. This moves the lower eyelid fat to the hollow just below at the level of the cheek-eyelid transition. This will minimize the possibility of lower lid hollowness.
I have posted a patient of mine that underwent blepharoplasty with transposition alone.
The eyelid bags represent herniated fat in the 3 compartments of the lower lids. It's good that you've rule out other medical issues as a cause for the bags. A trans-conjunctival approach under brief general anesthesia would involve conservative removal of the fat and restore the youthful contour to your lower lids. For many examples, please see the link below to our eyelid surgery photo Gallery
Looking at your photos, I suspect that your lower eyelid "bag" is not caused by herniated orbital fat. How can you tell? Take your finger tip and put it on the top of the "bag." If this feels hard, what you are feeling in the bony orbital rim. Surgery does not remove this type of bag. We don't chisel out the bone. Now if this is the bony orbital rim, this actually makes you very good candidate for hyaluronic acid fillers. Of these products, Restylane is the best of the products. The big problem is finding the right person to do the service. It is both an art and a science. It is best if you are treatment by someone close to home in case the treatment needs to be adjusted. Treatment for you will last a year or more.
jitterbug, you have congenital pseudoherniation which basically means you have too muck fat behind your eyelids. In this instance only do I recommend removing fat from all three compartments behind the orbital septum. At the same time you need a midface lift called a "SOOF lift blepharoplasty" to improve the hollow area beneath the eye. I teach this approach nationally. See my web site for futher information. Good luck!!
Lower eyelid congenital bags and treatment involves an experienced eyelid surgeon and removing ONLY the EXCESS fat with or without repositioning if u have hollows as well and is done thru a Transconjunctival approach only.