Eyes are looking tired, upper bleph and under eye fat transfer? (Photos)

Question

38 years old and looking into upper eye bleph and under eye fat grafting. Really wondering if this is the best route to rejuvenate the eye area. Am I a good candidate for both or either procedure? I constantly engage my forehead to lift my eyelids do to how heavy they are. My main concern is the tired look.

Natalie Plana, MD · Answer

You have a beautiful upper eyelid shape, and interestingly the heaviness you are experiencing is likely coming less from excess upper eyelid skin and more from the brow sitting lower than it ideally should. The fact that you recruit your forehead to feel more awake is a classic sign of this, and an endoscopic brow lift would address that directly by repositioning the brow into a naturally elevated position that mirrors the appearance you are already achieving on your own. 
For the under eye area, a transconjunctival lower blepharoplasty combined with fat grafting would beautifully address the early tear trough hollowing and tired appearance, removing the herniated fat pads through the inside of the eyelid with no external scar and restoring natural volume beneath the eye for a result that is refreshed and long lasting. 
Both procedures are performed outpatient and you go home the same day, with a recovery of approximately one week. Most patients experience some bruising and swelling around the eyes that is easily concealed with sunglasses, and the majority are comfortably back to work or school within that window. I think the combination of these two procedures could give you a really outstanding and natural result.
Please note that any thoughts shared here are based solely on the information and photos provided in this post, and are inherently limited without an in person examination. A definitive surgical recommendation can only be made following a comprehensive in-person consultation and assessment with a plastic surgeon.

Yasemin Aydinli, MD · Answer

Your heavy lids and the habit of lifting with your forehead suggest true excess upper-lid skin, which an upper blepharoplasty treats very well. For the under-eye area, the right tool depends on the cause: fat grafting or filler if it is hollowing, but a lower blepharoplasty if you have protruding fat bags. Many patients your age benefit from a combination, and brow position should be checked too, since a low brow can mimic heavy lids.

Julian De Silva, MD · Answer

Thank you for the photos and for mentioning that you constantly lift with your forehead. That detail matters more than people expect. When you recruit the forehead to hold the lids up, some of the heaviness is often coming from the brow position, not only from excess eyelid skin. If a surgeon treats the lid alone and the brow is the real driver, the tired look can persist. So the first thing I would assess in person is how much is upper eyelid skin, how much is brow, and whether there is any true droop of the lid margin (termed ptosis). For the under-eye area, in my opinion, fat grafting can help genuine hollowing, but it needs conservative, layered placement to avoid lumpiness. At 38 you may well need less than you think. A proper examination, looking at you both animated and at rest, is the only reliable way to separate these layers and treat the cause of the tiredness rather than chase it. As a surgeon who works only on faces, I would want to see all of that before recommending anything. Best of luck

Burhan Demir, MD · Answer

There does not appear to be a significant amount of excess upper eyelid skin. The tired appearance is mainly related to brow descent. A natural brow lift would likely provide a fresher and more rested look.
Regarding the lower eyelids, it is difficult to make a precise assessment because the photograph does not show the entire face. However, the eyelid–cheek junction appears relatively long. A midface lift can shorten this distance and improve the transition between the lower eyelid and the cheek.
The amount of lower eyelid fat is also difficult to evaluate accurately from brightly lit photographs. If there is only a small excess, a conservative fat excision may be sufficient. If the fat volume is more significant, a lower blepharoplasty with fat transposition may be a better option.
These are the procedures that could be considered. A final recommendation can be made after reviewing full-face photographs and discussing your expectations in detail.

Eyes are looking tired, upper bleph and under eye fat transfer? (Photos)

Answers (4)

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