My eyes always look tired. What procedure or service could help my undereyes? Lower bleph? (Photo)

Let’s start with the positives! Your brow position is excellent. Your upper eyelids are youthful and symmetrical. Your lower eyelid position is correct. You simply have a small amount of pseudoherniation of the fat from your lower eyelids. This should be easily corrected with a lower blephroplasty under either local anesthesia or general anesthesia. This will smooth the transition between your lower eyelid and your cheek and give you a more youthful and rested appearance. Have a detailed discussion with your plastic surgeon. Best wishes.

Hello and thank you for your question. A formal evaluation would be needed to determine the best treatment. There are both surgical and non-surgical options to correct this, depending on your specific situation.

For less significant puffiness and sagging UNDER the eyes, or more mild improvement, there are nonsurgical treatment options: we often use Renuvion helium plasma radiofrequency (RF) energy to achieve incredible results and take years off of your appearance. Combining RF energy and cool helium plasma, the signs of aging (wrinkles, pigmentation, skin laxity) are improved in a ‘Nonsurgical Lower Eyelid Lift.' The focused heating tightens and peels the outer skin layer with extreme precision, leaving the surrounding area undamaged, smoothing and tightening the periorbital skin, and improving the overall skin quality around the eyes. It's an aggressive treatment, and the recovery time is longer than with other nonsurgical procedures, but the results can be life-changing.​

Surgery (a lower blepharoplasty with or without canthopexy/canthoplasty or orbicularis muscle suspension) is a great option for more significant improvement- for example if there are more severe lower eyelid bags / bulging present. Sometimes the surgery can also be used to intentionally adjust the shape and/or size of your eyes, or correct any asymmetries!

Dr. Donald Groves is an expert facial plastic surgeon that I work with, who specializes in these types of procedures. It is important that if you are considering surgery that you go to someone who is well trained and very experienced with these delicate operations to get the best results. I suggest getting a consultation with an experienced cosmetic dermatologist and facial sculpting expert, or an aesthetic facial plastic surgeon like Dr. Groves; we are both located right here in Los Angeles.

Best,
Dr. Emer

You have prominence of fat underneath the eyelids and this is separate from the bulging. You would benefit from a lower blepharoplasty and release the septum to allow the fat to transfer to the tear trough and diminish the prominence you dislike.

Best Wishes,

Gary Horndeski, M.D.

From the photos provided, it appears that a robust HA volumizing filler would work well for contouring the face, and at the same time improving the under-eye areas and diminishing the smile lines. You would be wise to consult with an experienced, board certified cosmetic dermatologist filler expert, since expertise and experience are required by the injector to ensure that the specific contours of the female face are preserved, so as not to inadvertently masculinize the face. Hope this helps and best of luck.

From the photos it appears you have a few options to improve the under eye area. Fillers are one option to help smooth contours. The treatment is done in the office with results lasting up to a year. Lower blepharoplasty is a surgery that will address the fat herniation and any excess skin under the eye for a more permanent solution. Morpheus8 is another potential treatment which uses RF technology combined with microneedling to improve overall skin tone and texture. See a board certified plastic surgeon near you to learn more about your options.

This response was dictated using Word recognition.
My apologies for any potential grammatical errors.
Facial aesthetics are primarily determined by facial bone structure.
It may seem like the problems are related to soft tissues, but reality soft tissue problems are fundamentally based on their skeletal foundation.
Individuals who lack sufficient size and projection of their maxilla are prone to having issues with bulging of the lower eyelids and an appearance oflooking tired and aged prematurely.
The area you describe is fairly complex and not always easy to understand for both patients and providers.
There are usually two variables immediately adjacent to each other that create an appearance of age.
In a youthful face, the contour of the lower eyelid should be snug and tight.
The area immediately below the lower eyelid should be plump and full.
As we age, both of these areas can reverse in contour.
Patient can develop bulging of the lower eyelid And also an appearance of having lost volume in the upper midface just below the lower eyelid.
In some individuals bulging of the lower eyelids is the primary problem and in other individuals, the loss of volume immediately below this area is primary.
For some individuals it is both.
Treatments are usually aimed at either restoring the midface volume or reducing the bulging of the lower eyelids with fat removal through a procedure called the lower eyelid blepharoplasty.
Volume restoration of the midface can be accomplished in a number of ways.
Plastic surgeons have used implants, fillers, fat grafting, and a procedure called the midface lift.
The simplest treatment is probably well done volume restoration using fillers.
Simply having fillers may or may not improve your outcome.
Doing this kind of work well, requires skill and experience.
There are significant differences depending on who you choose as your provider.
To get an idea of what can be accomplished using only injectable fillers. I suggest you check out the website of Dr. David Mabrie MD in San Francisco. his website has an impressive collection of before, and after pictures of patients treated using only fillers.
David is a facial plastic surgeon whose practice is focused exclusively on using facial fillers.
His work is the best I’ve ever seen.
I’m not suggesting people fly to San Francisco to get facial fillers done but seeing his results can serve as a educational tool to get a good understanding of what can be accomplished with this fairly simple and straightforward procedure.
Fillers are temporary, and the treatment needs to be repeated to maintain the outcome.
Because the area is complex and there are many different ways of treating it you’ll probably get different opinions from different providers.
It’s not an easy or straightforward area to treat, and there are substantial differences depending on who you choose as a provider.
to get a better assessment and better understanding of treatment options and to begin provider selection, I suggest having multiple in person consultations with plastic surgeons in your community.
You can consult with plastic surgeons, facial plastic surgeons, or oculoplastic surgeons.
There may be providers from other specialties, who are doing work with facial fillers.
I think you’ll find that those who have the credentials to offer all the various procedures are in a better position to offer you the correct treatment since their choice of treatments is not limited.
Try to consult with the most qualified providers, regardless of what procedure you choose or who you choose as your provider.
During each consultation ask providers to show you plenty of the before, and after pictures.
Bring pictures of your own face taken the same way plastic surgeons take before and after pictures to use as a reference during the consultation.
In your case, removing some of the fat that’s bulging in the lower eyelid in conjunction with midface volume restoration would probably give you the best overall outcome.
You may be able to get a nice improvement from doing one of the two procedures but I think in your case, addressing both fullness in the lower eyelids and loss of volume in the midface Would be ideal.
Hopefully my attempt and explaining this is not too difficult to decipher.
I generally always recommend patients have multiple consultations before selecting a provider for any permanent irreversible aesthetic procedure.
Best,
Mats Hagstrom MD