Eyelid Surgery: Q&A

Ask a Question

Too Young for Lower Eyelid Surgery?

I am 20 years old and have been considering Lower Eyelid Surgery for about a year now. However, many of my friends and family disagree with my concerns. I'd like an opinion from a professional.

I first began to notice the puffiness under my eyes when I was 15 or 16, this is also when it began to bother me. It is hereditary, both my parents have puffy bags beneath their eyes. I dislike the appearance of my eyes and would like to change that. What do you think?

Tags:

Comment on this

16 Doctor Answers | Asked by whaleyb89 in Toronto, Ontario

Doctor Answers (16)
Community Comments (0)

Lower eyelid surgery and patient age

Lower eyelid surgery is usually not performed on most patients until they are over 40 years of age. On a rare occasion, a patient in their 30s with very severe bags, can have the procedure performed. The primary goal for lower eyelid blepharoplasty is removal of the fat bags, which cause a double bubble effect. There is usually no excess skin or muscle present until the fourth, fifth, or sixth decade of life.

There are many options for improving lower eyelids

You are absolutely correct that we generally consider an individual 20 years old to be too young to consider cosmetic lower eyelid surgery. In most cases, there is an alternative explantation for the apparent fullness, puffiness, or other asymmetry. There does appear to be a loss of smooth contour from your lower eyelash margin over your cheek area. This has resulted in a depression just superior to the bony rim underneath your eye. In our practice, we would generally recommend one of the... more

Too young for lower eyelid surgery?

Age is in an of itself not a reason not to perform surgery. Some patients have a congenital bulge that looks bad. If that bulge is due to a bulge of fat (usually associated with a forward set eyeball), it is a straightforward procedure to reduce it. If the muscle roll is too wide, that is a more difficult problem. Botox can diminish the roll, but not well. Cheeklifts can use muscle tailoring techniques if they are done through a lateral subciliary incision. In your case, as the other... more

Consider fat transfer first

Your primary problem is a contour issue related to prominent muscle thickening and a trough beneath the eyelid, referred to as a "tear trough". You might try a filler such as Juvederm first to see what correcting this will do for you, but I prefer fat transfer for long term correction of the hollows. Often this will restore a more youthful appearance than fat removal, the exception being some uncommon cases of hereditary premature fat herniation, especially at your age. more

Lower eyelid surgery will destroy your appearance

Dear Whaley Got to be careful what you look for. Someone will do eyelid surgery, right or wrong. I disagree with the doctors here who want to do something for your orbicularis. Your issue is the hollow under the orbicularis. The treatment for this is not surgical but a little filler in the form of Restylane. The treatment is very comfortable and last well beyond a year. Don't do surgery.

Kenneth D. Steinsapir, MD

8 reviews

Los Angeles Oculoplastic Surgeon

Lower eyelid surgery

If you do not wish to try a filler + Botox in the tear trough area then only than I might consider a transconjunvital lower lid blepharoplasty. But you really need to see 3 boarded surgeons to helps ypu determine the proper course of action.

Getting rid of lower eyelid puffiness can be done with minimal scars

Hi Whaleyb89 - Getting rid of the puffiness underneath your eyes can be done with a standard lower blepharoplasty or transconjunctival blepharoplasty. Both heal amazingly well with minimal scarring, and the transconjunctival one is done via incision inside the eyelids, so you have no scars! It's difficult to determine which procedure is best for you without examining you in person, so make sure you visit several surgeons before proceeding with surgery. Good luck!

Non-surgical blepahroplasty or eyelid surgery

I tend to agree with Dr. Rand's assessment. I do not see any prominent fat pads. I do see a bulge which appears to be muscle and a groove beneath this. The hyperactive muscle could be reduced with Botulinum Toxin whereas the tear through and hollowing could be filled with a hyaluronic product.

Otto Joseph Placik, MD

32 reviews

Chicago Plastic Surgeon

Consider fillers and Botox instead of eyelid surgery

Whaleyb, Although you may be a candidate for eyelid surgery, as you can see, not many of us would recommend it. I will agree with the majority faction here that you should try some Botox and perhaps a filler if the hollowing bothers you, as well as the puffiness. EVERYTHING we do may have consequences, especially surgery. Good luck!

No blepharoplasty required (or advised).

I agree with my colleagues here. The "puffiness" is actually muscle and should not be operated on. With caution, a small amount of Botox to the pre-tarsal orbicularis might lessen that appearance. The best approach would probably be a well placed filler such as Juvederm or Restylane to fill in the depression along the rim of the eye socket. Also, while surgeon's preferences vary, this is *not* an area where fat injections work well, IMO. All the best, --DCP

"Puffy" Lower Lids

I agree with Drs. Rand and Persky. Although there appears to be a mild skin laxity, the overwhelming appearance is due to the unveiling of the Tear Trough and size of the muscle. I would suggest you see a good Plastic surgeon / ENT for correction of the Tear Trough with Restylane. That would smooth the lower portion of the lids greatly. If still unhappy, consider a MINUTE amount of Botox in the lower lid roll (MUST be done by an experienced doctor - not a subordinate "injector").... more

Lower eye lid bulge is muscle

It looks like you have some bunching of the eye lid muscle just below your lashes. A procedure does exist that trims this muscle away but I would not recommend it at this time. Chances are the eye lid looks better in the morning and the more you squint and use your eye lid muscles the more prominent this area becomes. Since the bulge is due to muscle, you might try a very small dose of Botox in the muscle to let it shrink down. This has to be done very carefully and with very small doses to... more

Marcus L. Peterson, MD

4 reviews

Saint George Plastic Surgeon

Blepharoplasty in young patients

You are young, however, I do see something on your photos. You appear to have "hollow orbits" (eyes seem a bit sunken in), and possibly hypertrophy of your orbicularis oculi muscles (the lids themselves are full near the lash line). You may do better with fillers in this case than with blepharoplasty at this time.

Your orbicularis muscle is causing your puffiness

Looking at your picture, I don't think surgery is the right answer for you. You have puffiness just under your lashes that probably gets worse when you smile. That is the orbicularis muscle, the muscle that closes your eyes. When you're young, it can bunch up like that when you smile. A little Botox or Dysport can relax that nicely. Surgery on it is likely to cause other problems. As you get older, it will be less of a problem.

Too Young for Lower Eyelid Surgery?

Hi Whaley, "Whaley a minute!” I would not recommend lower eyelid surgery for you at this time. You may try Restylane to fill some of the minor hollowing under your eye, and or a few units of properly placed Botox to decrease some of the hyperactivity of your lower lid muscle. If those measures don't "cut it" then depending upon your examination, I might consider a lower eyelid skin pinch as a last resort. You are a beautiful young woman with pretty eyes and eyelids, so... more

Michael A. Persky, MD

21 reviews

Los Angeles Facial Plastic Surgeon

drpersky.com

Too young or just not a candidate for lower lid surgery?

What I see in your picture is a hypertrophic orbicularis muscle causing the puffy ridge just below your eyelashes. This is not a surgical problem and you are correct that it is hereditary. Actually, what I also see are hollows below the muscle, so called tear troughs, which could be filled with Juvederm or Restylane and this will minimize the appearance of puffiness in the muscle just above that.