Would you recommend a blepharoplasty? (Photo)

Hi, I've have bags under my eyes and hooded eyelids; these issues always been pronounced since I have a small face and big eyes. Now I'm 35, and my eye issues seem to have gotten worse; they are especially prominent when I smile. Not only do I have lots of lines, but the corners of my eyes turn down. I've gotten filler injected about 4 times in the past year to help with my under eye bags, which has helped a little. Does anyone have a recommendation?

Doctor Answers 7

Blepharoplasty candidate

The photographs demonstrate the early changes of aging around the eyelids. A very conservative skin only upper blepharoplasty can improve the upper eyelids and excess hooded skin. A conservative trans-conjunctival approach lower blepharoplasty can remove a small amount of fat creating the puffiness look. Botox is best used for treatment of the crows feet when animating. For best results and a natural look, choose a surgeon with extensive experience with the procedure. Anticipate visible bruising and swelling for two weeks after the surgical procedure, which is performed under brief general anesthetic. For more information, and many blepharoplasty before-and-afters, please see the link and the video below

Seattle Facial Plastic Surgeon
4.7 out of 5 stars 126 reviews

Eyelid rejuvenation

Hello and thanks for posting your question and photos!Based on the pictures you posted you may benefit quite a bit from simple upper eyelid blepharoplasty and transconjunctival lower lid fat removal procedures. Additional improvement of the area can be gained by improving the skin quality of the lid area with botox treatment of the crows feet and laser skin resurfacing of the face and lower lids (like Fraxel: Dual) . I'd recommend that you meet with a reputable, board certified plastic surgeon to discuss your unique case and best options to reach your goal.

Rachel Streu, MD
Portland Plastic Surgeon
5.0 out of 5 stars 14 reviews

Blepharoplasty or not?

 Your lower lids can be improved with a transconjuctival blepharoplasty and fat reposition. Your eyes look sad because of sagging brows and u should NOT have an upper blepharoplasty but rather a Browlift. If your hairline is low = endoscopic but if high you need the procedure we invented =The Irregular Trichophytic Forehead Lift which can even lower your hairline if u want but NOT raise it  no scar noticeable since hair grows thru it!  Make sure u see the surgeons hairline  

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 32 reviews


Dear Burns1006, In patients your age who begin to have aging in the upper third of the face I like to perform an endoscopic browlift with mid-face suspension. This allows the brows to be placed back to their pre-aging position and opens up the eyes without having eyelid skin removed. This gives the patient a very natural and youthful looking appearance with no tell tale signs of surgery as the small incisions are hidden in the hairline. You will also see improvement in the lower eyelids with this procedure.  I would advise not adding any more filler to this area. Laser skin resurfacing and botox to the area will further reduce the fine lines that you see. See the link below for multiple examples of patients your age as well as the video above. Best regards, Michael V. Elam, M.D.

Michael Elam, MD
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 196 reviews

A skin only blepharoplasty is simply not going to get the job done.

You do not just have hooding.  You have upper eyelid ptosis.  The ptosis needs to be repaired so the upper eyelid margin does not hang low on the eyes.  The upper eyelid hooding needs to be adjusted to the new future upper eyelid height.  You should know that standard upper blepharoplasty generally is made with an upper eyelid incision that is too high and too much of the upper eyelid fold.  That full upper eyelid is an essential feature of your face.  You do not what to have eyelid surgery and end up looking like Rene Zellweger. The key is eyelid structure.  Your ptosis needs to be repaired, a small amount of skin should be removed (approximately 6 mm or less), and an anchor blepharoplasty is needed to support your eyelashes.  The lower eyelid should not have surgery.  I believe all you need here is a chemical peel. Less is more.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
4.9 out of 5 stars 23 reviews

Would You Recommend Blepharoplasty?

Thank you for your question and photos. Whenever we assess the upper eyelids, it is extremely important to start with the actual brow position. Many patients I've seen ask for an upper blepharoplasty, but on exam, actually have a brow that is ptotic (sagging/drooping). This ptosis causes 'lateral hooding' which will not be corrected with blepharoplasty alone. Once the brow is elevated to a more youthful position, an accurate assessment of the presence/absence of actual excess upper lid skin can be made. This requires an in-person examination with your local plastic surgeon. The photos of your lower lids demonstrate both static and dynamic wrinkles. Static wrinkles are caused by aging changes & sun damage, and are present at rest. Dynamic wrinkles appear with animation, and are caused by the pulling effect of muscles. Static wrinkles can be treated well with any number of topical therapies including lite laser peels. Botox is very helpful in diminishing dynamic wrinkles.

Michael F. Bohley, MD
Portland Plastic Surgeon
4.9 out of 5 stars 15 reviews

Pause before considering incisional surgery

Your photo is very helpful, as it demonstrates that you primarily have volume loss and skin aging in your eye region, rather than actual skin excess/descent. This is a common configuration for early aging changes in the eye region. Rather than incisional surgery to remove skin, you are a perfect candidate for a permanent volume augmentation and intrinsic skin rejuvenation via autologous fat transfer and dual pass fractionated skin resurfacing. Fat transfer is a wonderful treatment to improve contour changes above and below the eyes. Laser is powerful for reversing the age related skin changes of elasticity loss and textural changes. Together, laser and fat transfer are synergistic, achieving more together than they can on their own as the laser shrink wraps the skin, while the fat transfer expands the volume from below. Incisional surgery may very well be in your future, but at this point I would suggest taking the non incisional route to achieve a more natural and effective rejuvenation via fat transfer and resurfacing. Hope this is helpful for you- find a surgeon who is well versed in all these methodologies who can examine you and give you personalized feedback. Good luck!

Tanuj Nakra, MD, FACS
Austin Oculoplastic Surgeon
5.0 out of 5 stars 21 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.