What would be the least invasive procedure to correct under high bags and saggy eye lids and any other suggestions? (photo)

I am 52 and am disgusted with my eyes please let me know what the best procedure would be

Doctor Answers (3)

Eyelid surgery done under local anesthesia is more convenient for the patient and quickens recovery time

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A few years ago, I wrote a book called “The Fine Art of Looking Younger” where I explained that facial aging is a combination of volume loss and sagging. One factor that can cause aging is genetics. As a cosmetic oculoplastic surgeon practicing for 20 years, this type of question is what I hear pretty much every day my practice.

You have extra skin over the eyelid which we call dermatochalasis. You also have puffiness under the eyes which we refer to as lower eyelid fat prolapse. I think that the ultimate solution after reviewing your photos is a surgical solution. In the modern world, a lot of procedures are marketed that propose or claim to do less invasive procedures which result the same as surgical procedures.

As a specialist in this area and whose practice is mainly cosmetic surgery, I see patients from all over the world who have had too much skin removed from the upper eyelids and the lower eyelids are pulled down. I think that a certain amount of those patients have a preventable situation. This means that understanding the support structures of the eyelid to provide multiple levels of anatomic restructuring or repair is very important. So it is important the surgeon is able to evaluate the patient before a procedure like pulling down the lower eyelid and looking at the tone, resilience, strength and elasticity of the eyelid.

In our practice, we developed a quick recovery method that includes several components. One is natural and artistic-looking surgery. Years ago, many surgeons were doing surgeries in a very invasive way which meant that the patient will go under general anesthesia. Ultimately, I think that your least invasive procedure is a combination of a certain level of expertise, artistry and avoiding unnecessary anesthesia. We do all procedures using local anesthesia with light sedation called LITE™ anesthesia. This means a little injection of anesthesia and having the patient wide awake throughout the procedure. Over the years, we mastered a certain style of doing sedation so that the patient doesn’t have significant trauma in contrast to having a tube in their throat and put under general anesthesia where your body is fully paralyzed.

I think you would need an upper lower eyelid blepharoplasty. This procedure is a very long lasting procedure. I have seen many of my patients that as they got older, they tell me 10 years later that their eyes have held up very well. In our practice, we do other things such as the application of platelet-rich plasma. Platelet-rich plasma is a very advanced concept amongst doctors who perform surgery which is very used commonly in orthopedics and oral surgery. It is using your own blood and separating the platelets and the serum which have the growth factors. This helps a lot of our patients to have better results with their eyelid surgery with having rejuvenated and improved quality of skin and getting that nice luster and volume to the skin.

I advise against the so-called non-invasive procedures which technically is equally invasive as surgery. Heating devices whether it’s from ultrasound, radio wave or laser can permanently affect the skin by making it thinner. You simply cannot address upper eyelid or lower eyelid skin with just a heating device alone. In addition, when the skin is sagging or has diminished elasticity and the structure has changed, then adding volume with the use of injectable would actually stretch that structure and create various irregularities.

At this point, I think that it would be advisable that you meet with several experienced qualified cosmetic surgeons who really know their way around eyes and get a sense of their experience, their ability, technical skills and their results. Look at the before and after pictures of their actual patients and get comfortable with how to have this done. I hope that was helpful, I wish you the best of luck, and thank you for your question.


New York Oculoplastic Surgeon
4.5 out of 5 stars 32 reviews

There is no easy way to improve your eyelids.

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You are going to need some sort of surgery to help with the excess skin.  You have a lot of laxity of the lower eyelid tissues, and will probably need both surgical excision of skin, and some sort of filler or laser.  Your surgeon will be able to discuss a variety of options with you.

John J. Martin, Jr., MD
Coral Gables Oculoplastic Surgeon
4.5 out of 5 stars 8 reviews

Essential to understand that you have a very complicated eyelid situation.

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Honestly you need a personal assessment to really permit an accurate evaluation of what eyelid resources you have to help improve your appearance.  I would look to see how upper eyelid ptosis is contributing to your upper eyelid.  You might benefit from sub-brow Restylane.  The lower eyelid situation is complicated and you look like you need the skin and orbicularis oculi muscle of the lower eyelid redrapped to the orbitomalar ligament.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
5.0 out of 5 stars 17 reviews

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