29 yr old female considering lower eyelid blepharoplasty. Am I a candidate? Is there an alternative/superior solution? (photos)
Doctor Answers (13)
Options to remove under eye bags
In situations in which there isn't an excessive amount of fat a great option is to improve the lower eyelid volume which ends up better covering the normal existing eyelid fat.
In some people there is both too much eyelid fat and not enough surrounding soft tissue coverage. In these cases a plan involving a combined approach in which a lower eyelid blepharoplasty is done to remove some excess fat along with facial fat grafting to better fill in the deficient areas of the lower eyelid and cheek.
It's hard to say what would be the best approach in your case based off of just your photos. You do have a component of volume loss that could be treated with a soft tissue filler (such as restylane) or facial fat grafting. An in person exam would allow for a better assessment as to whether any excess lower lid fat is present that needs to be removed.
You can check out my web reference below to see a great example of a patient of mine who had her lower eyelid bags treated with facial fat grafting alone (no eyelid fat was removed).
Congenital lower eyelid fat prolapse
Though laser resurfacing can sometimes help in this area to improve the pigment changes, in your case, because of your darker skin tone, it can be more risky.
I've attached photos of a similar anatomic problem in a young patient.
Lower eyelid surgery
Young patients like you benefit from conservative excision of the excess fat through an incision inside the eyelid (trans-conjunctival). I would also recommend using some of the fat to drape into the tear trough medially to smooth this area out. You can get an idea how this will improve the eyelid by gently compressing the baggy area in with a Q-tip. Just smoothing out the contour makes the dark circles less noticiable.
It's super important for your surgeon not to over do the fat resection. You don't want to look hollowed out in another 20 years.
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Puffy lower eyelids
Fillers for hollows: I like restylane in the tear trough and this can mask the puffiness that you have and is a reasonable non-surgical options to get some immediate improvement. I have seen this filler last more than eight years in this area. I don't think permanent (Artefill) or semi-permanent fillers are as safe in this region (search sculptra on realself).
Surgery: Transfer of the fat (incision hidden on the inside of the lower lid) from the puffy area into the hollow tear trough area is a procedure with a very high likelyhood of solving your concerns based on your photos (the variety of angles really helps give us some clues about how this looks in 3D). It is my experience that this procedure is highly successful with minimal risk especially if performed by someone who does alot of these procedures around the eyes. An oculofacial plastic surgeon would be an excellent choice.
Laser: Resurfacing of the skin in this area can help reduce or get rid of wrinkles and sometime improve the darkening (hyperpigmentation) of the skin. The skin may be hyperpigmented for a short time in the early post operative period. This is generally easily managed with topical medication.
Botox: Neurotoxins such as Botox are generally fabulous at controlling wrinkling around the eyes. These can be used alone or in combination with other therapies. I tell patients not to have botox beneath the eye when they have lower lid puffiness until the fat herniation has been surgically managed or the botox may actually make that area look worse.
As you can see. Multimodal therapy directed at each of the individual problems can give patients a very natural improvement of the facial features they are unhappy with right now.
Lower eyelid blepharoplasty with fat repositioning looks like a good surgical alternatives.
29 yr old female considering lower eyelid blepharoplasty. Am I a candidate? Is there an alternative/superior solution?
Following the advice of anyone who would presume to tell you what to do based on limited 2 dimensional photos 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
Lower eyelid bags
Options for Improving Tired Lower Eyelids
In your case, you would be an excellent candidate for a surgical lower eyelid lift or treatment with injectable fillers depending on your goals and expectations. A consultation with an experienced eyelid surgeon should help you find a treatment that is right for you.
Options for lower eyelid bags giving tired appearance
Fat and discoloration
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.