This is a common problem and I see it in a lot of my patients.
I recommend scheduling an in office consultation with your local board
certified facial plastic surgeon to determine if surgical or non-surgical
treatments are your best option.
Although it is difficult to determine accurately from your images, you may
have mid-face volume loss as well. If
this is the case, you may benefit from dermal filler or fat transfer to your
mid-face area. This can decrease the
natural step off under your eye while helping to camouflage the area. In addition, you could consider dermal
fillers or fat transfer to further correct the under eye hollowness—this can
sometimes reduce the dark discoloration as well.
A complete examination is required before you should consider surgery. If you have a sinus issue that could preclude doing surgery.
You do have several options:
1- Fillers to "camouflage" the "bags". I prefer Belotero that that area
2- A conservative lower trans-conj blepharoplasty to remove some of the fat
3- A peri orbital laser re surfacing to tighten the skin over the "bags": Fraxel or ProFractional.
For patients your age, I usually recommend 2- and 3-
Hope it helps!
Henri P. Gaboriau MD FACS
Yes you can have a transconjunctival blepharoplasty without an incision outside. The other alternative to to use a filler to camouflage the fat bags by injecting into the tear tough under the fat bags. I often see patients who have the injections because they do not want the surgery until later in life.
Twenty one is a young age to be considering lower blepharoplasty, but then again, age becomes less relevant if the problem exists regardless. From your photo, you would benefit from lower blepharoplasty where some of the fat in the bulge is transferred to the hollow (tear trough). However, if you wish to defer surgery, filler injection into the hollow of the tear trough will certainly improve things, and you can continue this option for quite a while before contemplating surgery. You should know, however, that in the last few years, cases of blindness have been reported, resulting from injection of filler in and around this area. This is a rare and unusual complication that has been reported with lower blepharoplasty surgery too. On probability alone, it would be very unlikely to happen to you, but I'm just making the point that, injection or surgery, nothing is risk-free.
Surgery choices are not always specific to age alone they depend on the patients diagnosis as well as other hereditary factors. You have excess fat and a lower lid blepharoplasty would be helpful to smooth this area out. I would not rule out surgery in favor of fillers due to your age. I would perform a transcongetival lower lid blepharoplasty not removing any skin and just remove the excess fat and release the tissues allowing a smooth youthful appearance. Best regards, Michael V. Elam, M.D.
There is no "ideal" time to perform a lower lid blepharoplasty. It is purely patient dependent and needs to be done when its the right time for you. You will likely have an improved appearance with a lower lid blepharoplasty and have an improved lower lid cheek junction and less pronounced tear trough deformity. Good luck,
Even at your age your have aging of the lower eyelids that will eventually need a surgical correction. You could try to delay surgery with dermal fillers to the tear trough zone and upper malar zone. A lower eyelid blepharoplasty would smooth the transition zone between your lower eyelid and cheek yielding a more rested appearance.
You actually have beautiful eyes, but a little prominent fat in the lower lids with a tear trough beneath the fat pad. A carefully done partial reduction of the fat pad and transfer of some of the fat into the tear trough would look great, but you are so young maybe try some fillers first.
Looking at your photos, you have a true excess of fat of your lower eyelids, and the best results would be with a lower lid blepharoplasty, with removal of some fat, and some repositioning, with release of some of the tissues to allow a smooth transition between the eyelid and cheek. The results should last a long time. Fillers or fat can be used without surgery with some improvement, but it will only be partial. The surgery can easily be done from inside the eyelid (transconjuctival), so there will be no visible scar. Experience is important: it is a mistake to remove too much fat, which can leave a hollowed out appearance, which worsens with age. However, this surgery can be very gratifying, and in patients like you, age 21 is not too young..