As a cosmetic oculofacial surgeon specializing in
facial aging surgery for 20 years, I do a lot of lower and upper eyelid surgery
as well as face and neck lifts. First, let’s understand that the lower and
upper eyelids are in a very unique space called the orbit. Although you can
physically move everything, which we call the mirror lift, it may look better
but it is not in a level that is sustainable when you do aggressive face
lifting. Lower eyelid surgery and face lifting procedure are two separate
procedures. Although there may be some secondary benefit to the lower eyelid by
repositioning the cheek as occurs in a facelift, trying to change the lower
eyelid position, tone and overall appearance from a face lifting procedure will
not likely be successful.
The lower eyelid is a very complex structure. As
a specialist, I deal with patients from all over the world, where they had
lower eyelid surgery by board certified plastic surgeons and they have had
severe lower eyelid retraction, skin loss, exposure and their lower eyelid was
disconnected from their outer corners. Lower eyelid anatomy is complex and sometimes
surgeons who don’t have specialized training will get themselves in trouble. The
lower eyelid tone and position is so critical - it is important point in your
decision-making process when you meet with prospective doctors in choosing who
to do your lower eyelid surgery.
Very often, we will combine the lower eyelid
surgery with the face and neck lift surgery. When you meet with a doctor, the
way to understand if the doctor is at a
mastery level of the lower eyelid surgery is by doing various tests to check
the tone of the lower eyelid, such as a pull test or a snap test. With that,
there are options on how to ensure that the lower eyelid position is maintained
or enhanced with procedures such as lateral tarsal strip. When you are doing
your consultations, you may decide whether to do the procedures together or to
do them separately. With your level of anxiety it might be practical to do the
lower eyelids first to make sure everything turns out right.
In our practice, we don’t use general anesthesia
routinely for any procedure. We do everything in local LITE sedation™. By doing
that, our patients can make decisions based on their own comfort rather than the
incentive to do as much as you can while going under general anesthesia.
Learn more about your situation and meet with
qualified experienced cosmetic surgeons about your lower eyelids, facelifts and
neck lifts. Once you feel comfortable, move forward and have these procedures
done. I hope that was helpful, I wish you the best of luck, and thank you for
Based on your photographs I believe the puffiness below your lower eyelids are festoons or malar bags. If I am correct then a lower blepharoplasty will accentuate the festoons and make them look worse. Please consult an expert board certified plastic surgeon who is experienced at oculoplastic surgery for an examination and evaluation.
Hello and thank you for your question.
photos are limited, it looks as though you would benefit from a face/neck lift.
In addition, upper and lower blepharoplasty. However, you have festoons which
are difficult to treat. For a more thorough discussion regarding this, I
recommend that you see a board certified plastic surgeon in consultation to get
more specific answers to your questions which can best be addressed after a
thorough history and examination is performed.
Best of luck to you!
Thank you for your question. Reviewing your photos, I would say that you seem to have a good grasp of your facial structures. One clarification I would like to make is that a facelift is really a lower face and necklift. This would not address your lower eyes. To address both areas, you would need both procedures. I would temper your expectations for the lower lids because of the presence of festooning (the more prominent swelling just below the lower eyelid). These are not an easy problem to deal with and a standard lower blepharoplasty is unlikely to make these go away entirely. There are options for festoons, but none of them are perfect for every patient. As always, its best to see a surgeon who is well respected and performs all the procedures you are considering. A hands-on, in-person consultation is likely to be the best and most informative option to find someone you have confidence in and a good rapport with.
Sometime it makes a lot of sense to have more than one procedure. Carefully do your homework. Surgery should be natural, not be life threatening, and not cause complications. That is easier said than done. Finding the right surgeon is a huge challenge. If you see a doctor and it does not feel right, move on. Listen to your feelings about this. Remember cosmetic surgery is not a necessity. Take you time.
You have some lower facial heaviness with marionette lines, jowls, and some neck fat. You would benefit from neck liposuction, probable platysmaplasty, and facelift. The lower eyelids show some festooning. A lower eyelid bleph can help with this, but it can be very difficult to eliminate the festoons in some patients. With the bleph and some laser resurfacing you can usually tighten this skin up to make it look smoother. In the side photo it looks like you outer brow is low causing some extra skin folds of the lid. You would benefit from a temporal browlift.