Many options for the lower eyelids

 There are several techniques that are effective for the lower eyelids depending upon what needs to be altered.  

Laser resurfacing is great for tightening loose skin, removing pigmentation and sun damage and for smoothing wrinkles.  For bulging fat pads, surgery is still the best treatment and can be done without deep general anesthesia. Almost all of my eyelid procedures are done under local anesthesia with some oral sedation ( valium or ativan).  

Filling in hollows or a prominent tear trough such as what is shown in your picture is most often accomplished either through moving or repositioning fat during a lower eyelid surgery, or by injecting hyaluronic acid fillers such as Juvederm or Restylane.  These are simple in office, out patient procedures that require simple local anesthesia, ice packs and about 20 minutes of time.  The filler is placed in the hollow or shadow and plumps the skin to create a smooth contour.  Some bruising may occur, but when performed properly it is a safe procedure.

Of course, some patients will require a combination of these procedures to accomplish the ideal outcome.  When you are ready for another treatment, consult your cosmetic surgeon to find out the best options for you.

The lower eyes are a tricky area.  If you just remove fat, hollowness ensues.  If you remove skin in order to tighten the area, the corners of the eye pull down.  This in turn causes a rounding of the eye or a distored eye shape.

Yet the lower eyelid has both hollowness and bulges as fat deflates and the center mass of the cheek slides downward.

In our practice we prefer to perform an ultrashort incision cheeklift to tighten the lower eyelid skin.

The premise of this procedure is that when skin is tightened, the tissue must first be GIVEN to the lower eyelid, not taken from it.  A cheeklift does this by elevating the cheek, "giving" tissue to the lower eyelid, thereby enabling safe tightening that does not alter eye shape.

Laser resurfacing does tighten the skin and we use it frequently, but does not accomplish the structural changes your eye would need to get the best result.

Remember the cheeklift is the trickiest operation in plastic surgery, in my opinion, so be careful to choose a surgeon with great experience in the area.

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