Hello, Do you think I'm a good candidate for blepharoplasty? Approx 5 years ago I had teosyal injected to correct dark circles with poor results (after the injection my eyes were lumpy and overfilled). The skin under my eyes was never quite the same after that. Would laser treatments like thermage be an option as well? I'm 32 years old. Thanks for your input, I really appreciate you time!
Is Lower Blepharoplasty the Best Option for Under Eye Bags? (photo)
Doctor Answers (5)
Too young for dark circles under eye
Hello, I have a bit of a different opinion regarding best treatment options. You are young and pretty, but you have hyperpigmentation (dark circles) on your lower lids caused by a tear trough ligament which causes a relative lower lid depression. This is best treated with a trans-cutaneous (skin) incision with disruption of the offending ligament and fat removal and re-positioning to give a smoother appearance and eliminate the shadowing. I think that a trans-conjunctival procedure is appealing because no outside incision is used. This will not correct the underlying anatomic issue and could add hollowing which would increase the problem. I would use fillers for a bit and consider surgery down the road
Transconjunctival lower eyelid blepharoplasty with fat repositioning
The nasojugal groove (tear trough) forms at the transition between the lower eyelid and the cheek. Fat herniating from the lid above it, and volume lost below it, cause the tear trough to become more pronounced.
Taking some of the herniated fat and repositioning it into the area of hollowing (the tear trough) will help to smooth this contour and reduce the appearance of the under eye bags. Simply removing this fat may give you a decent result now, but may contribute to an even more hollowed appearance as you get older.
Transconjunctival Lower Blepharoplasty for Under Eye Bags
You may have success with a transconjunctival lower blepharoplasty for lower eyelid fat removal. What you are describing and your photos suggest that what you are seeing is a mild anount of herniated fat. There are no other effective options for this concern.
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Non-surgical eyelid rejuvenation
If you are seeking improvement and rejuvenation of the lower eyelids then there are two methods, surgical and non-surgical. Non surgical improvement consists of soft tissue fillers such as Juvederm. In addition to soft tissue fillers you may consider microablative fractionated CO2 laser treatment such as SmartSkin and SmartXide will help to tighten the skin. These can be performed in combination. With the degree of puffiness you have of your lower eyelids I would recommend non-surgical methods.
Transconjununctival fat repositioning
Repositioning the lower eyelid fat into the tear trough region would be your best bet if you wanted to stay away from further fillers in the lower eyelid. You seem to have some makeup on which makes it difficult to assess the skin texture to see whether a mild peel would also be beneficial.