Is Lower Blepharoplasty (and or Eyelid Lift) Surgery Right for Me? (photo)

I'm a 34 year old female who has a permanent " tired" look. I don' t know how my appearance could change so much within a year.. I read that if the tired appearance is due to loss of fat causing hollowness of the eye that a blepharoplasty would make it worst. Is this true? It' s difficult to assess from a picture, but do I look like a good candidate for this surgery? If not, What would you recommend? I am seeking a permanent solution. Any well known Surgeons in Montreal for this surgery?

Doctor Answers (15)

Addressing the whole eyelid-cheek area for a natural look

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As a cosmetic eyelid specialist, I’ve encountered a lot of questions about lower eyelid blepharoplasty, and was asked a couple of times if it is an appropriate procedure for my patients who have problems with their eyelids. I usually tell them that a single solution is not enough for people who have more than one issue.

 

When I communicate with my patients about rejuvenation of the eyes, I always include the cheek. I feel that the eyelid and cheeks always have to be balanced. As someone who also does facelifts, I always look at the eyes and beyond when people describe a particular problem, because as soon as their problem is resolved, there will always be a problem that we can anticipate. We don’t necessarily have to address it in the time of surgery, but we can prevent problems from occurring.

Looking at your photos it is clear you have bulging fat pockets under the eyes called lower eyelid fat prolapse or herniated fat. This means that fat that is normally behind the eye has pushed forward and created a bulge. In addition, there’s also a lot of relative hollowing the at rim of the eye as well as in the cheek area.

 

In my opinion, I recommend a volume enhancement of the cheek area. This can also be combined with the lower eyelid procedure. For example, I would put a submalar or cheek implant to add volume to the cheek area. If the patient is hesitant about that procedure, I would do a fat transfer instead to add volume to the cheek. This way, the eyelid and cheek will look balanced. This is related to the fact that facial anatomy is very individual. We can do things to enhance but we can’t radically change the basic structure. All we surgeons could do is to maximize the appearance to its potential.

For patients who have a long and thin face, they usually risk having the eyelid pulling down with the external incision approach, so I would recommend a transconjunctival blepharoplasty. It is a routine procedure where I reduce the fat pockets from inside the eyelid. Perhaps at a later time, we can enhance the lower eyelid to cheek junction with a filler such as Restylane. I would also apply something called platelet rich plasma, which is derived from your own blood.  It is a concentration of the healing elements of the blood called the platelets. This would help with skin quality and skin texture.

 

My suggestion is that you find a cosmetic surgeon who understands a plan that is more comprehensive than just being focused on one issue such as the fat pockets. Both of you should work together so that in the course of time, you can get the best appearance possible. I hope this is helpful to you, and thanks again for your question.


New York Oculoplastic Surgeon
4.5 out of 5 stars 21 reviews

Blepharoplasty Candidate?

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Thank you for the picture.  It does not appear that you have very much excess skin.  I believe that a blepharoplasty with redistribution of your fat to help the hollowness and improve the stark nasojugal groove would be beneficial.  A detailed examination is in order for you to get the most accurate recommendation.

Dr. ES

Earl Stephenson, Jr., MD, DDS
Atlanta Plastic Surgeon
5.0 out of 5 stars 8 reviews

Lower eyelid surgery

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A very common aging change in the lower eyelids is the development of 'bags', which are in most cases due to an outward bulging of the fat pads behind the lower lids. These 'bags' of fat can be improved by conservative removal through an invisible incision on the inside of the lower lid (trans-conjunctival approach) in patients that do not require skin excision, or through the under-eyelash (sub-ciliary approach) in patients that are having some excess lower lid skin removed.

As with skin removal, I believe that the reduction (NOT total removal) of lower lid fat pads should be conservative. Excessive removal of lower lid fat pads results in a hollowed-out appearance that makes blepharoplasty patients look tired or even ill. I see quite a number of eyelid surgery patients who require structural fat grafting of the lower lids to improve that very problem following an over-aggressive lower blepharoplasty in the past.

In some case lower lid 'bags' can be improved by repairing or reinforcing the soft tissues that normally hold them back. Additionally, excessive lower lid fat can sometimes be mobilized and transposed inferiorly to fill in periorbital hollows or depressions such as the 'tear trough' at the medial junction of the lower lid and cheek.

Some eyelid 'bags' involve redundant muscle tissue which must be removed and/or repositioned, usually in patients who are in their sixties or older. This is performed through an under-eyelid (sub-ciliary) incision which is extended laterally into the 'crow's feet' area.

Structural Fat Grafting of the Lower Lid

As mentioned above, it is very important to preserve (or restore) soft tissue volume in the lower lid. When I review with eyelid surgery patients some photographs from their twenties, in most cases we find that years ago there was no visible demarcation between lid and cheek, but instead a smooth, gently convex curve extending downward from the lower lid margin.

In patients who have developed deep 'tear troughs' at the junction of the lower lid and cheek, adjacent to the side of the nose, the meticulous grafting of fat harvested from the patient's abdomen, hips or thighs can build this area back up and nicely restore a more youthful contour. In some blepharoplasty patients this depression or 'hollow' extends horizontally across the entire junction of the lower lid and cheek, and this must be corrected to obtain the ideal postoperative result.

In select patients, lower lid rejuvenation may consist of conservative reduction (not removal) of the lower lid fat pads or 'bags', in combination with structural fat grafting of the 'tear trough' hollow immediately below. As with all aesthetic surgical procedures, it is absolutely essential to customize the surgical plan to the specific needs of every patient.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.5 out of 5 stars 37 reviews

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Bulging lower lid fat

+1

Your photos certainly show bulging of your lower lid fat pockets. Yes you have slight scleral show but that is not unattractive at your young age. I would keep it simple and recomend transconjuctival (inside) blepharoplasty to remove the fat and avoid any repositioning of the lid itself. The attached video explains transconjunctival lower eyelid blepharoplasty.

Thomas Buonassisi, MD
Vancouver Facial Plastic Surgeon
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Lower eyelid surgery for tired look.

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Every answer discusses the bags or fat herniation which is what gives the tired look. However, only a few address the scleral show or white area showing below the iris and outer aspect of the eye that gives a sad or 'puppy dog' appearance. I think it would be highly advisable to have a canthoplasty which will reposition the lower eyelid and cover this lateral aspect and give a more esthetically pleasing look to your eyes.  

Brian J. Lee, MD
Fort Wayne Plastic Surgeon
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Is Lower Blepharoplasty (and or Eyelid Lift) Surgery Right for Me?

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You have some findings of scleral show, herniated peri orbital fat pads, and tear trough deformity. The operation is more than just injecting fat or fillers. A lateral canthopexy/plasty, removal or thinning the herniated fat pads and a filler or fat transposition/graft to troughs. Fee range from $4,000 to $6,000. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
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Lower bleph in 34 year old

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  This site, and the web, are full of suggestions that you may delay (temporarily) surgery by using fillers to treat the under eye hollows.  Personally, I think you would be an excellent candidate for transconjunctival lower eyelid blepharoplasty with conservative fat removal and possible fat redraping to the under eye hollows. I would not be afraid of the surgery although I would be very careful when selecting your physician.

Lawrence Kass, MD
Saint Petersburg Oculoplastic Surgeon
4.5 out of 5 stars 35 reviews

Scarless eye lift

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 I have had great success with the transconjunctival approach in younger patients with the type of appearance you present. This is sometimes referred to erroneously as "incisionless" eye lift. There is an incision, it's just that it is on the inside and so no one sees the  scar. Your skin at your age should have good elasticity, and so I find that fat grafting is rarely needed.  I have done fillers instead of surgery in situations similar to yours, but in the long run that would be more expensive, since it would have to be repeated. Check out the American Society of Aesthetic Plastic Surgeons web site for the names of plastic surgeons in your area

Paul W. Loewenstein, MD
Milwaukee Plastic Surgeon
4.5 out of 5 stars 14 reviews

Lower eyelid surgery

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Dear Sky34,

  • I do not know of anyone in Montreal, but close by in New Jersey
  • You would be an excellent candidate for surgery to remove the fat pockets, then use fat grafting to fill the hollows and sculpt the eyelid
  • This would make for a nice transition so you can't tell where the eyelid stops and the cheek starts
  • Finally, you can use some volume along the outer rim which is what fat grafting would be great for

Best regards,

Nima Shemirai

Nima Shemirani, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 21 reviews

Lower eyelid issues

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It looks like you have some loewr eyelid fat hernation as well as hollowing. Removing some fat may be beneficial.  Some of the fat can be used for  redraping or you can have filler placed in the hollows.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 15 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.