Age 45 - advice for lower lids & midface sagging? (Photos)

Great questions! Surgery is absolutely the longer lasting option. You would of course need an examination to determine lid laxity, vector analysis, among other things..but from the pictures alone I think you would be a great candidate for a lower blepharoplasty with midface lift and volume augmentation via fat grafting. By repositioning the fat in your lower lid, not just removing it, we can eliminate the dark circles and smooth out the nasojugal groove as well. Finally, for the optimum results a concomitant profractional laser will tighten up that periorbital skin. It looks like you may have a bit of upper lid ptosis (droop), that if addressed would also give a more youthful and energetic appearance, but that is often just related to the photograph/camera technique and again would need to be examined!

Based on your photos, you do not appear to have a terribly flat mid facial appearance. I do see a bit of a bluish discoloration under your eyes which could be from previous HA filler. Unfortunately, based on your photos, it is difficult to address your concerns. Thank you for your question. Sincerely, Dr. Joseph

Your eyebrows are slightly below the orbital rim. I recommend a frontal browlift to lower your hairline, decrease the vertical height of your forehead and pull up the eyebrows. The browlift can be extended down to the level of your inferior ear to pull up the mid face at the same time. In terms of the lower eyelids, bleaching can be done for the discoloration. I would also recommend a lip lift. A lip lift does 4 things: shortens the distance between your nose and upper lip, increases the mucosa of the upper lip, increases the incisor show and pulls up the corners.

Best Wishes,

Gary Horndeski, M.D.

The filler is old enough that it is holding extra water and making you look puffy. That is relevant because that extra volume actually makes you look 10 years older than you should. Remove the filler and instantly you will look much younger. No the enzyme does not "wreck" your skin. You may need a very small amount of filler in the under eye area and around the mouth. You do have upper eyelid ptosis and I would recommend having that thoughtfully corrected.

There is no doubt that in your case fat grafts, micro and nano, would be a better option for volume correction and dark circles. In some cases fat grafting may need to be repeated 8-12 months in order to built necessary volume. This is very sensitive technique and you should make effort to find an experienced board certified plastic surgeon to evaluate and treat you. Good luck.