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I have dark deep creases under eyes, fatty bulge, and deep tear through. Am I a Good Candidate for Lower Blepharoplasty? (photo)

I was so grateful for all professional advice received on previous post.Looking for answers again. I have dark deep creases under eyes, above them small fatty bulge, tear through area also deep. I am concern surgery may create a more sunken look or accentuate the dark creases? Not interested in fillers.Is Blepharoplasty for me? fat repositionning?Is there enough fat to reposition? Should I see an oculoplastic surgeon? Recommendations in Montreal?This tired look took my self confidence away!

Doctor Answers (17)

Possible candidate for lower blepharoplasty

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I would say that you are a good candidate for lower blepharoplasty.  There are a variety of techniques that could be used to improve your appearance and each surgeon may have a preference of one over the others.  Unfortunately, I do not have a recommendation for a particular surgeon in Montreal, but I would recommend seeing either a facial plastic surgeon, plastic surgeon, or occuloplastic surgeon for a consultation.  In that consultation, you should be able to get your options for surgery.    

San Francisco Facial Plastic Surgeon
5.0 out of 5 stars 14 reviews

Lower eyelid blepharoplasty - good candidate

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You would be a good candidate for a lower eyelid blepharoplasty with fat repositioning with resuspension of the orbicularis muscle and a small amount of skin removal.  You would also benefit from a lateral suspension of the malar fat pad.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 11 reviews

Approaching the whole eyelid-cheek area for best results

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I wrote a book called “The Fine Art of Looking Younger” where I discussed that I always explain to my patients why somebody looks the way they do in a certain stage of their life. Facial aging has two processes: one of them is volume loss which includes bone, muscle and fat; The other process is sagging where the skin and underlying tissue starts to diminish. Everyone ages differently and it has to do with genetics.

By looking at your photos, I have observed that you have a very lean face and there is not a lot of volume. I also observed that there is puffiness under your eyes. Honestly, you can’t have a single definitive solution for all these issues.

When I solve issues like yours, I look at the eyelid and cheek as one area, described as the eyelid and cheek relationship. As we get older, the volume in the cheek starts to shrink and flatten out. We lose that nice ledge and shape such that the eyes can have a bulge of fat. Whether you do fat repositioning,  fat preserving or fat resecting procedure, it won’t address the volume in the cheek adequately. It will address the volume in the eye but it won’t necessarily address the volume in the cheek. Sometimes we offer a fat transfer where we take fat from one part of the body and place it into the cheek area to give it some volume. We can also place a cheek or sub-malar implant to help improve the volume and the hollowness that’s under the eye.

I also tell my patients that the approach to facial rejuvenation doesn’t have to be addressed all at once. The patient and I discuss a plan composed of a series of little steps. I try to prioritize what are the most important things and what we can do outside of the operating room such as fillers etc. I would suggest that you try to understand the basis why fillers exist and, even if one doesn’t believe in them, that they can be helpful.

A consultation with an experienced cosmetic surgeon is very important. Every surgeon is not the same. A certain type of patient looks for a certain type of doctor. Meet with a cosmetic surgeon to learn your options and get a sense of their artistic style. I suggest a lower eyelid blepharoplasty, something to address volume in the cheek and doing it in a small step-by-step way so that you feel comfortable and you don’t regret having done something. I hope this was helpful to you, and thank you for your question.

Amiya Prasad, MD
New York Oculoplastic Surgeon
4.5 out of 5 stars 40 reviews

Lower Eyelid Surgery Techniques

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In general, depressions or creases underneath the eye that have a small fatty bulge respond well to procedures that reposition fat.  An experienced plastic surgeon who is skilled in blepharoplasty or an experienced oculoplastic surgeon can give a nice result. In the last several years, techniques have evolved that can likely help you a great deal with surgery, but experience is very important.  Reviewing post-operative pictures can help you be realistic about what can be achieved.

Transconjuctival blepharoplasty candidate

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Obviously an in person exam would be critical but based on  your photos and young age I would likely recomend a transconjunctival lower lid blepharoplasty. The results look very natural with no external incisions. I dont think you would need a fat transfer but that would be an option. A surgeon in your area with extensive experience in lower lid blepharoplasty would be recomended. Below is some information to help better understand the procedure.

Thomas Buonassisi, MD
Vancouver Facial Plastic Surgeon
5.0 out of 5 stars 64 reviews

Lower eyelid surgery

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From your photos, it looks like you do have fat bulges in your lower eyelids. They can be removed easily with surgery. It is hard to tell whether you have excessive skin or wrinkled skin as the skin has to be dealt with as well. Ablative laser can be used to shrink your lower eyelid skin at the same time the fat is removed.If you have excessive skin, then it needs to be removed.


David Ellis MD FRCSC

Toronto Facial Plastic Surgeon

Art of Facial Surgery

David A. F. Ellis, MD
Toronto Facial Plastic Surgeon
4.5 out of 5 stars 2 reviews

Blepharoplasty improving eyelid contour

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It appears that you would be a good candidate for lower eyelid blepharoplasty.  I think it is likely that fat repositioning would be indicated to help fill the tear troughs.  Skin tightening could be accomplished with either a resurfacing procedure or a pinch excision.

Mark Beaty, MD
Atlanta Facial Plastic Surgeon
5.0 out of 5 stars 15 reviews

Lower eyelid surgery to correct deformities

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I would recommend a lower blepharoplasty with minimal fat removal, and fat repositioning or grafting to the hollow areas, or tear trough. You should have enough excess eyelid fat for this. A transconjunctival approach is ideal for you, using an incision inside the lower lid. A conservative laser or chemical peel will tighten the skin adequately and help the dark circles most likely. A facial plastic or occuloplastic surgeon is recommended, or a general plastic surgeon who performs frequent blepharoplasty.

Harrison C. Putman III, MD
Peoria Facial Plastic Surgeon
5.0 out of 5 stars 12 reviews

Lower blepharoplasty candidate

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 You are  a great candidate for a lower transcontinental blepharoplasty for removal of  fatty deposits and a pinch  technique for excess skin.   The skin pinch involves a small incision on the external portion of the  eyelid at the lash line and a very conservative amount of skin is removed. The incision is closed with Histocryl tissue glue. For example similar to your own, please see our photo gallery

William Portuese, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 60 reviews

Candidate for lower blepharoplasty

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Based upon the photos you submitted, it appears that you would be a good candidate for transconjunctival lower blepharoplasty perhaps with fat transposition. Depending upon your skin type a pinch or a laser procedure to tighten the lower lid skin may also be helpful. I am sure there are many qualified physicians in the Montreal area.

Scott Trimas, MD
Jacksonville Facial Plastic Surgeon
5.0 out of 5 stars 10 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.