At 20 Years Old, Would a Blepharoplasty Be Possible?

Or should I only consider fillers? I am only 20 years old but I have had under eye bags since I was around 13. I was wondering if I am to young for an under eye blepharoplasty procedure and if that would give me the best long term results considering my age. Also, could just using fillers fix my under eye bags and how long do fillers usually last?

Doctor Answers 8

Lower Eyelid Rejuvenation

Aesthetic lower eyelid procedures (blepharoplasty) are best performed on patients with excess skin or bulging fat below their eyes. This is often seen as wrinkly skin or bags beneath the eyes. By tightening the skin and removing the excess fat, the eyes will look refreshed and rejuvenated. Often times, excess skin and fat is not the problem and patients present with hollowing of the upper cheek area. This hollowing can contribute to looking aged and tired. Filling these hollows (tear troughs) with a filler such as belotero or fat can improve the overall aesthetic appearance without surgery. Consult with a board certified plastic surgeon to determine the best treatment option for you.

Boca Raton Plastic Surgeon
4.8 out of 5 stars 19 reviews

Lower lid surgery in a 20 year old

It is difficult to evaluate your concerns with just a photograph. If you have bulging fat this can be treated delicately by removing it from an incision inside the lid( transconjunctival). If it is just a shadow a filler may be helpful, but it would be better evaluated in person.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 28 reviews

Lower lid blepharoplasty in 20 year olds

It is important to understand what a lower lid blepharoplasty usually involves and what it is being done for. In your case it would be done purely to remove the fat pads below the lower eyelids so that they cannot bulge or bag forward and currently this must be done directly rather than indirectly by suction or some sort of injection. Clearly there is no bagging or excess of the skin, so a lower lid blepharoplasty for you would not involve removal of any skin.

There are two options. One is the trans-conjuctival approach from behind the eyelid and the other is the usual external incision but without extending out laterally and not removing any skin. The former has no external scar and the latter offers more direct control and completeness. Both will cause bruising and swelling that will be obvious for at least a week, possibly longer, although it is healed by a week. 

Scott L. Replogle, MD
Boulder Plastic Surgeon
4.0 out of 5 stars 1 review

Blepharoplasty, eyelid surgery

Yes, you could have a lower eyelid procedure. I now do less fat removal in that area but more repositioning of the fat so it is less likely that you end up with a hollow look now or in the future.

Edward J. Domanskis, MD
Newport Beach Plastic Surgeon
4.4 out of 5 stars 27 reviews

Fixing hereditary eyelid bags

Based upon your pictures you provided, I would indeed recommend a lower blepharoplasty done from behind the eyelid called a transconjunctival blepharoplasty. It is a long term and perhaps permanent correction for lower lid bags. I have frequently done the procedure on folks in their twenty's or thirty's that were born with these bags called hereditary fat pseudoherniation in medical jargon. I am not a big fan of fillers for younger folks around the lower eyelids and at most it would last a year. Removing the fat bags is a safe long term correction that can be done without visible scarring.  I would definitely recommend the transconjunctival approach and avoid the scar. I hope this information helps.

Scott Trimas, MD
Jacksonville Facial Plastic Surgeon
5.0 out of 5 stars 20 reviews

You have very big eyes increasing your risk for lower eyelid surgery

It is not impossible for you to have lower eyelid surgery.  However, I would not recommend it.  The risk of you damaging your eyelids permanently is very high.  You have very large eyes and this increases the risk for an adverse outcome from lower eyelid surgery.  Your best option for many years will be an artful lower eyelid filler treatment with Restylane.  The service lasts well over a year.  The bad news is that it is an art form.  Don't expect to go down to the corner spa where a nurse has set up shop and get the treatment you need.  You are going to have to find a very talented injector to get the best possible results.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Lower eyelid problems and age

While most eyelid concerns are related to involutional changes that occur with age, there is no rule as to when a corrective procedure should or should not be done. Some people are born with lower eyelid anatomy that creates puffiness, dark circles, or other cosmetic concens. Therefore your specific problem and not your age should determine the appropriateness of a treatment course.

Given that you are 20, there are pros and cons to both surgical and non-surgical interventions. You obviously want something that lasts but also don't want to be too aggressive in your approach to the problem.

First, it is hard to tell from the picture whether your issue is a fat issue or a thickened muscle issue. That is an important distinction to make.

Secondly, you should always make sure that allergy, hormonal imbalances, or a thyroid disorder is not the root cause of lower eyelid fullness. These questions are more important the younger you are.

In terms of treatment, I think that fillers and/or limited botox injections to the area would give a very nice result. FIllers, such as Juvederm or Restylane,  tend to last about a year in the under eye area. I personally do not recommend Sculptra or Radiesse in the lower eyelids, although other physicians use these products safely in this area. The downside is the need to repeat these treatments every 1-1.5 years.

A lower lid blepharoplasty is probably a little too much for you at this point in time since the puffiness is not so bad. You would be going through a lot of healing time and financial investment if you chose to pursue that path. However, if you did have a corrective lid procedure, I am certain there would be an enduring benefit.

Hope this helps and best of luck

Richard W. Westreich, MD
Manhattan Facial Plastic Surgeon
5.0 out of 5 stars 51 reviews

Bags under eyes and blepharoplasty

Young patients may exhibit a process termed blepharochalasis.  This typically occurs in young females and can sometimes even be associated with inflammation and pain. It can effect both the upper or lower eyelid but typically occurs in the upper eyelid.  Lower eyelid fat pseudoherniation causes the bags under the eyes which can be treated with a lower blepharoplasty or eyelid lift.  Non-surgical options such as filler injection can lead to moderate improvement in the right hands and are temporary. 

Etai Funk, MD
Houston Facial Plastic Surgeon
4.8 out of 5 stars 63 reviews

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.