Most expert experienced artistic
plastic surgeons have a variety of procedures at their disposal to produce
excellent cosmetic results in the appropriately selected patient: temporary
fillers for the hollows under the fat pads, micro-fat grafts for the hollows, and blepharoplasties. Each has benefits and drawbacks. Fat
grafts or fillers alone will not produce as pleasing cosmetic result as a blepharoplasty. Any procedure should be performed conservatively in order to achieve a natural result without any long term problems.
Following the advice of anyone who
would presume to tell you what to do without taking a full medical history, examining you, feeling and assessing your tissue tone,
discussing your desired outcome and fully informing you about the pros and cons
of each option would not be in your best interest. Find a plastic surgeon that
you are comfortable with and one that you trust and listen to his or her
advice. The surgeon should be certified by the American Board of Plastic
Surgery and ideally a member of the American Society for Aesthetic Plastic
Surgery (ASAPS). You should discuss your concerns with that surgeon in person.
Robert Singer, MD FACS
La Jolla, California
Fullness under the eyes often is due to herniation of some of the fat that is around your eye. Typically, the fullness caused by this process does not improve with cosmetics. A lower eyelid blepharoplasty is a procedure to remove the excess fat that is protruding forward and giving you the appearance of eyelid bags. There are several techniques to accomplish this goal. A transconjunctival approach utilizes an incision from inside the the eyelid to access the fat pads rather then utilizing an incision through the skin. This approach has a significantly lower risk of weakening the eyelid and causing a change in eyelid position. From the photos that you posted, you appear to be a good candidate for this procedure, but an in office visit is important to further assess your eyelid area.
Unfortunately, your pictures are not of high enough resolution to allow any specific advice. There are several things that contribute to under eye bags. Mostly this is lack of fill and tissue descent at 48. Excess fat can cause it at a younger age. Though hard to tell, your pictures seem to show mainly lack of fill. This can be corrected by filling the area over the orbital rim with a filler or fat. This fills the malar area and pushes up the cheek eliminating the "bags." If this does not totally correct them, then a filler above the orbital septum could be tried. This requires more care since all the fillers we have available in the lUS tend to absorb some water and can cause excess puffiness above what is achieved initially. Make sure whomever you see for this is an expert injector.
Certainly the best thing to do is to see an eyelid specialist to examine you in person. But from looking at your pictures, you could improve your appearance with some work on the lower lids. If you don't want surgery, you could put some filler into the tear trough which would help to smooth out the appearance. A surgical option would be a lower eyelid blepharoplasty where the fat pads that you see can be moved with a fat repositioning surgery. A small amount of skin may be removed if needed. Having this surgery done will not result in the lid drooping later in life! See an oculoplastic surgeon who can go over these options with you.
Thanks for the question. Lower lid surgery can correct much of what you are concerned about. Fat and skin excess improvements are the goals of lower lid surgery, but it has to be done carefully and somewhat conservatively. Always proceed to get opinions from several experts before proceeding with surgery. Obviously I am partial to consulting a Plastic Surgeon for this assistance.
Feel confident in moving forward with your inquiries, and good luck to you.
Frank Rieger MD. Tampa Plastic Surgeon
Dear Professor. Bulging of the eyelids can be corrected by several techniques. Mild bulging is amenable to fat dissolving injections with a filler injected below the bag. This will usually result in a partial correction. More severe cases may require removal and repositioning of the fat as well as tightening of the eyelid muscle to prevent recurrent bulging. The skin of the eyelid is quite elastic and typically will shrink and accommodate once the bulging fat is removed. Meticulous technique and respect of the eyelid laminae will usually prevent complications. Cheers