I have a very pronounced tear line and hollow eyes, never troubled me . A month ago the eyelid and skin suddenly drop, loose skin is making the line of tear line worse plus my eyes look less sharp. I have been suggested temporal fillers on tear line to push up, but I hate the idea after one year will be the same story again. Id like fat transfer but seems that area is rigth the most difficult one. Thanks Could be eye lift up tightening orbicular muscle or other procedoure like cantoplexia?
I got Baggy eyes suddenly. Which way to solve it? (photo)
Doctor Answers 4
Lower eyelid blepharoplasty with fat transfer may be a good option for you.
You have some hollowing of the lower eyelid. You have a small amount of fat prolapse but from the photos it doesn't look like you have enough fat to get a good result with a fat reposition. When you see your surgeon, they may recommend a tightening of the lower lid if you have some laxity there. A pinch of skin will also help with the redundant skin you have. A fat transfer can be done to this area with great results. As you state, it is not the easiest area to do, so make sure you go to an experienced surgeon!
You may have some laxity in the lower eyelids. Some options for specialized tightening procedure and eyelid skin treatments
The eye area is very sensitive to the effects of environment and stress. I wrote a book called “The Fine Art of Looking Younger” where I explained that facial aging has to do with two basic issues: volume loss and descent or sagging. Volume loss is impacted in some people in their 30s or 40s, and sagging tends to occur a little bit later. Volume loss doesn’t only mean hollowing under the eye - it also affects bone, muscle, fat, skin and soft tissue. With all these areas being affected, it is understandable that laxity can be interpreted as excess skin.
When I evaluate a person like you in my office, I do a few things to understand what the situation is. First of all, I look at the anatomy and structure of the lower eyelid. The lower eyelid is connected to two parts of the bony part of the eye and sometimes there is an area of laxity particularly in the lateral area called the lateral canthal tendon. If that’s the case, then tightening procedures such as canthoplasty or canthopexy, lateral tarsal strip and orbicularis muscle strap are all good options.
I’ll also share with you a procedure not commonly done. To address skin quality under the eyes, we use something called platelet-rich plasma. Platelet-rich plasma is your own blood that is centrifuged or spun to concentrate a part of the blood called the serum platelets and plasma. This has tremendous benefit in improving skin quality in the eyelid area, in the face for acne scars and for wrinkles. Athletes are also using injections of platelet-rich plasma for joint and chronic injuries. Sometimes we combine this with thermal treatment conservatively because from my experience, I found out that excess thermal energy has resulted in skin getting thin. That said, a technology that we use called fractional CO2 laser has been very advantageous for a lot of our patients because there is a certain resurfacing component when the top layer of skin is freshened up.
To add volume in the tear trough or under eye area, fillers such as Restylane or something in the hyaluronic acid family can be very effective. We have also seen synergy in the combination of hyaluronic acid with platelet-rich plasma. Unfortunately, there is some variation. Just like everybody can exercise and develop muscle differently, the response to the hyaluronic acid and the platelet-rich plasma has to be observed to determine the frequency of repeat treatments. I would not recommend fat transfer directly into thin eyelid skin area. I have had patients who have come from all over the world requesting excision and removal of fat that didn’t turnout well. The reality of fat transfers is because fat and fatty tissue can heal in an irregular way and the skin is not very forgiving.
Think also about the eyelid to cheek junction. When you think about the relatively hollowing of the eye, you also have to think about the volume loss in the cheek area. For men, it is not much of an issue as it is for women but it is something to be mindful in terms of the overall strategy of making your eyes look better.
There is no perfect solution which is a singular, surgical and one-time one when we talk about volume loss. There is a strategy, finesse, artistry and clinical observation. At this point, it’s best that you meet with some qualified experienced surgeon who is very familiar and comfortable in this area. I hope that was helpful, I wish you the best of luck, and thank you for question.
Treatment options for lower eyelid bags.
Among many treatment options, IMO, lower eyelid surgery consisting of release of arcus marginalis ligaments, redistribution of orbital fat and conservative skin excision would probably give you the best aesthetic outcome. You may also benefit from a some type canthal tightening procedure if your lower eyelid tissues are lax.
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Lower lid blepharoplasty with fat transposition
If you are averse to fat grafting to this region, another good alternative would be fat transposition lower eyelid blepharoplasty. This would improve the contour of the tear trough in a more permanent way than fillers. A conservative skin pinch would improve the fine lines a bit as well.
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.