I Was Looking to Get Lower Blepharolasty? (photo)

So.. I am just going to post up two pictures from a photo shoot I did for work. 1 with out edit and 1 with. I know that my goal to have flawless not baggy eyes will not be as good as my edited shot but it is the direction I want to head in. So just wondering if this surgery is my best one. I am only 32 and I look tired and rundown all the time.. Lord knows makeup doesn't help and I am tired of it! thanks in advance

Doctor Answers 18

Improving under eye fullness

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Reviewing your pictures indicates some herniation of fat in the lower lid which would best improve with a surgical lower blepharoplasty. In my hands I would approach this through a transconjuctival approach with a skin pinch. I also believe that you can achieve moderate improvement with soft tissue filler injection of the tear troughs.

Cambridge Facial Plastic Surgeon


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In our practice we would recommend that Blepharoplasty for just your lower eyelids would give you a nice refreshed looked. You do have excess skin and removing it would be the only way to get long lasting results.


Stuart B. Kincaid, MD, FACS (in memoriam)
Beverly Hills Plastic Surgeon

Lower Blepharoplasty in the Young

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You appear to have both congenital and age related changes to your lower eyelids. Because of the congenital component, you are probably one of the few people where removal of some of the fat of the lower eyelids is indicated. You will still need to have the rest of the fat retained but moved to pad the lower bony orbital rim. You appear to also require removal of excess skin. Therefore, you appear to need a full skin/muscle blepharoplasty. You may be able to correct some of this with fillers, but they will probably not really achieve your desired correction. 

Robert T. Buchanan, MD
Highlands Plastic Surgeon

Lower blepharoplasty at young age

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A lower blepharoplasty at a young age is performed through a transconjunctival approach to remove the herniated fat pads from the lower lids.  There are 3 fat pads in the lower lids that are removed during a lower lid transconjunctival blepharoplasty to rejuvenate the area.  Over age 50 a small strip of skin is usually removed, but at age 30 a simple transconjunctival approach is often all that is required.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 157 reviews

Treatment of Tired Eyes

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The eyes can appear tired or aged due to excess skin, protruding fat or malpositioning of the eyelid.  In your case the pseudoherniation, or protruding fat, appears to be the primary concern.  I would want to see a profile view and get a closer look at your skin texture.  A transconjunctival blepharoplasty to remove or reposition the fat would be a good option for you with possible fat transfer or filler to address the contour irregularities.  Laser or chemical peel of the eyelid skin could also be considered to smooth the skin texture.


Jill Hessler, MD
Palo Alto Facial Plastic Surgeon
4.9 out of 5 stars 32 reviews

Refreshing your eyes.

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It appears that you have a combination of factors, such as loose, wrinkled skin, fat puffs and muscle fullness, that create your tired look.  A lower eyelid lift can contour the fat, muscle, and skin, creating a smoother, more youthful appearance.  For any fine lines on the eyelid, a TCA peel will improve the skin texture.  Finally, if a slight depression persists along the medial (inner) junction of your eyelid and cheek, the so-called tear trough region, then a judicious placement of filler can smooth that out.  This combination approach can refresh the appearance of your eyes nicely, creating a more vibrant look.

Richard G. Schwartz, MD
West Palm Beach Plastic Surgeon
5.0 out of 5 stars 32 reviews

Lower eyelid surgery

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Your untouched posted photo shows an upper bulge of muscle and a lower bulge of fat in each lower eyelid as well as significant skin wrinkling between 3 and 5 o'clock in the skin surround the eye socket. If you inject a filler or fat between the lower fat bulge and the cheek it will not do anything for the upper bulge. A transconjunctival approach will also not address the upper muscle bulge. If on examination the fat bulge remains prominent during the full range of eyeball motion you may be better off suturing the eyelid fat to the deep cheek fat and thinning the muscle along with botox to the crow's foot area. It does not look like you have much if any extra eyelid skin to remove. Vision correction to prevent recurrence related to squinting or allergy relief could help you keep your result.

The nasolabial fold can also be addressed by an injectable filler or fat graft to make you look more like the touched up photo.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon

Lower blepharoplasty vs injections

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Dear Kelly,
You have premature aging and fatty herniation of your lower eyelids. Blepharoplasty will indeed address both those in addition to transposing fat to your tear troughs. Injectables like Restylane are a temporary, long lasting but less invasive option to soften the bagginess, however, won't address the extra skin. I also noticed that your nasolabial folds were touched up as well. This area can be injected with fillers like Juvederm, or if you are planning a surgical route, your own fat. Best of luck.

Kevin Tehrani, MD, FACS
New York Plastic Surgeon
4.7 out of 5 stars 112 reviews

Eyelid bags

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You have two options:  1) filling the hollow area underneath the "bags" by injecting filler;  2) lower blepharoplasty with transposition (moving) the fat/bags to lower position.  There are pros and cons to both options.  See an oculoplastic surgeon.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 91 reviews

Lower Blepharoplasty or Restylane Injection in Eye Lid Hollows?

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Hi Kellyanne,

After examining your eyes in person, a decision would be made as to the best treatment.  The choice would be between surgical transconjunctival blepharoplasty with skin pinch versus skin pinch alone versus injection of Restylane in the eye hollows.  Most importantly, choose your treating physician most carefully.  Good luck and be well.

Dr. P

Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 39 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.