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Lateral Lower Eye Hollowness After Lower Eyelid Surgery. Next Option?

asked 9 months ago by Lin in MA in Mashpee MA
Latest answer by Manish H. Shah, MD
Question viewed 333 times
Tags: under eyes, hollowness, options

4 months ago I had lower eye surgery to correct a tear trough deformity (arcus margillis release fat repositioning). Although this surgery helped with the tear trough area I still have hollowness in the lateral portion of the lower eye, where the cheek meets the lower eye. Lower eyelid pinch, laser and filler have been suggested. What is the best option?

8 answers to Lateral Lower Eye Hollowness After Lower Eyelid Surgery. Next Option?

+2

Fat Grafting following Eyelid surgery

Many of my brow-upper lid junction structural fat grafting patients have come to my practice for the correction of hollowness created by the over-zealous removal of fat during an upper blepharoplasty surgery. I am continually amazed at how many cosmetic surgeons practice 1970's-era blepharoplasty surgery in the 21st century. I almost never remove upper lid fat during blepharoplasty surgery, and in many cases I actually add fat at the brow-upper lid junction. Fortunately, essentially all... more
Michael Law, MD

Raleigh-Durham Plastic Surgeon

michaellawmd.com

+2

You may be a candidate for a well-performed Injectable Filler procedure to add volume to your lower eyelids.

I read your concern and reviewed your photo. You may want to consult a specialist comfortable using fillers in your delicate lower eyelids. This is an unforgiving area so the expertise of your doctor is critical. I prefer to use Silikon-1000, an off-label filler for permanent results. I hope this is helpful for you. Dr. Joseph see video
Eric M. Joseph, MD

West Orange Facial Plastic Surgeon
+2

You do not demonstrate a malar bag!

Lin Lower eyelid surgery does make the lower eyelid less full. I think your surgeon probably did a great job for you. Of course you did not provide before photos. However you have very thin lower eyelid skin. What impressess me is that you do not look like you have had eyelid surgery. I agree that you do have a visible orbitomalar groove. This is not the same thing as a "malar bag" which would live just below the hollow you demonstrate... more
Kenneth D. Steinsapir, MD

Los Angeles Oculoplastic Surgeon
+2

Try filler first!

Fat repositioning is excellent for the medial tear trough, but is often inadequate laterally. The lateral orbital fat is a different type of fat, more fibrous and harder to reposition. This hollow you have should be easy to treat with a filler. Midface lift is a longer term solution but is a much bigger procedure than filler. You may also still have some residual swelling in the "malar bags" that will improve over the next year or so.
J. Charles Finn, MD

Raleigh-Durham Facial Plastic Surgeon
+1

Another option is fat.

Hello Lin, Another option for revolumizing this are is the use of autologous fat. Micro fat grafting can fill up this area and remove the "hollow" look that you complain about. Ask your surgeon about this option. Good luck, Dr. Shah
Manish H. Shah, MD

Denver Plastic Surgeon
+1

Lower lid hollow after surgery

Lin- Nice job with the photo. The lower eyelid contour issues can be difficult to illustrate unless no direct flash is used. Your photo shows a hollowing along the outer aspect of the rim, unmasking a "malar bag" in the process. In my experience this is one of the pitfalls of the arcus marginalis release and fat repositioning, in that it only fills the inner half of the rim area. At this point, you have three basic choices: Enjoy the partial correction, and do... more
Yoash R. Enzer, MD

Providence Oculoplastic Surgeon

www.doctorenzer.com

+1

Lower eyelid surgery or fillers

You may have some hollowing or the malar bag as noted. it is possible you have both. the simplist start is a filler such as juvederm.. this can be disolved if it doesnt look right. silikon is permanent and may not be the best start. if you like the appearance with juvederm , than fat grafting (or silikon) can be considered. more surgery would be my last choice
Jed H. Horowitz, MD

Orange County Plastic Surgeon
+1

A few thoughts to improve your eyes

It seems that you have what are called "malar bags". This can be difficult to correct with eyelid surgery alone. You may need a cheek lift or facelift. I think that a filler or fat grafting would be a reasonable simple alternative that would be helpful too. Your photograph also suggests that you have marked retraction of the skin of the upper eyelid and some drooping of the upper eyelid suggesting that the levator muscle, which lifts the eyelid, has become partially... more
Rodney A. Green, MD

Cleveland Plastic Surgeon

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