What can be done to correct my lower eyelids? (photos)

Question

I (28) am deeply concerned with my lower eyelids (and deep tear through on the right side). FYI: I already experienced fillers (restylane refine) and I experienced prolonging swelling and lymphatic problems (came with time) - got hyaluronidaze Last year (after 4 years). So fillers or fat injection is no option for me!

Sam Speron, MD, FACS · Answer

This is a common question.  Horizontal eyelid wrinkles and sogginess can be corrected with blepharoplasty or cosmetic eyelid surgery. It is one of the first cosmetic surgeries people usually get. While the average age might be 30 to 50's, some patients get this done in their 20s. It really depends on your unique anatomy as well as what exactly is bothering you.

Botox injections as well as laser treatments can also be a tremendous benefit if you are not interested in surgery. Of course, there are also many combinations.

A mini facelift or midface lift is another great option for many people to correct malar bags and other signs of aging around the eyelids. The recovery & downtime is very minimal. There are usually no drains, most people can go out the same day, you can shower the next day, there are no scars behind the ears and you can wear your hair up anytime and most patients take no pain medicine. There are never any guarantees of course with any procedure whether it is surgical or nonsurgical in nature.

I would recommend that you see a board-certified plastic surgeon in your area that is a member of both ASPS & ASAPS and performs a lot of eyelid lifts but also offers all the nonsurgical options such as injectables and laser treatments. Go over your concerns with them and make sure above all, you walk out of there with several options and an idea of the pros and cons to each of them as well as realistic expectations.

Alan Gonzalez, MD, FACS · Answer

Hello @Modest747664, thank you for your question. The type of Surgery you require must be performed by an oculoplastic surgeon. It is important that you have a consultation with a board certified specialist to determine a surgical plan according to your needs. Best wishes! Alan Gonzalez MD, FACS.

Thomas A. Mustoe, MD, FACS · Answer

Unfortunately prolonged swelling after filler to lower eyelids is an uncommon but real problem.  In my experience many patients have responded favorably to fat grafting in that area and I have never seen a prolonged inflammatory reaction ( undoubtedly because it is your own fat)z. The tear trough is part due to adherence of the orbicularis muscle to the bony rim and a transconjuctoval approach with release of that area and placement of fat should greatly improve the appearance.

Jason Emer, MD · Answer

Fillers like Belotero, Volbella, and Restylane Silk are good for improving under the eyes, but keep in mind that a combination approach will give the most improvement. My patients try to get non-surgical treatments to avoid surgery, so we use fillers, lasers, microneedling/PRP and stem cells. I suggest consulting with an expert to develop a treatment plan best suited for you. Best, Dr. Emer​​​​

Jonathan Kulbersh, MD · Answer

Thank you for posting your question and photos. Lower blepharoplasty is likely your best option to correct your lower eyelid concerns. This minimally invasive procedure can tighten loose muscles, remove excess skin, and reposition fat below the eye to create a firmer and smoother appearance.
This may produce a more seamless transition from the lower eyelid to the upper cheek area, creating a brighter result that can last for up to 10 years or more. I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon who can suggest which approach may be best for you.

Cory Bovenzi, MD · Answer

Hi and thanks for your question! I would say you would be a candidate for a lower transconjunctival blepharoplasty to remove/ reposition the fat from your lower eyelids causing those bags. I will say that depending on your surgeon's technique- fat removal vs repositioning you may desire more volume afterwards in the right areas to avoid a hollowed look. I would not recommend Restylane Refyne though- instead, microfat injection, Restylane-L, and Belotero are more suitable for the undereye area.
Best of luck!

Luis Eduardo Guerrero, MD · Answer

Hello, thanks for you question. Looking at your pictures it seems that your main problem is the prominent eyebag, this is due undereye fat extrusion.Your best option is a lower lid blepharoplasty, removing the fat excess by an internal incision (invisible scar) (transconjunctival approach). 
I hope this info be useful for you.

Zachary Farhood, MD · Answer

Your pictures demonstrate pseudoherniation of orbital fat, which results in lower eyelid bags. In younger patients such as yourself, fillers can be an option, but the results tend to be modest. The other option would be to perform a lower blepharoplasty where the fat is either repositioned or removed. Fat grafting can be done in select patients to improve contour around the cheeks. Although it does result in some prolonged swelling for the first few months, it should resolve. Fillers have some degree of hydrophilicity (drawing in water) so that may be why you had issues with Restylane previously.

Nelson Lee Novick, MD · Answer

The photos and the history of filler use under the eyes is consistent with what has lately been called under eye "puffy pillows."  More accurately, this is lymphatic obstruction (lymphedema), which can result from the use of an an inappropriate filler and/or too superficial placement of the filler within the delicate under eye tissues. The problem typically starts a long while after the treatments and does not usually respond at all or well-enough to hyaluronidase. I have had gratifying results when dealing with patients who have come to me with this problem using an algorithm of intralesional anti-inflammatory injections. Make sure to consult with an experienced, board certified cosmetic dermatologist. Best of luck.

Robert T. Buchanan, MD (retired) · Answer

I am sorry for your previous experience. This is, unfortunately, all too common as the great majority of injectors use the wrong filler placed in the wrong place. The results are frequently what you experienced. What you need is a heavy filler like Juvederm Voluma or Radiesse placed deep on the bone or muscle below the orbital ligament by a true expert. Other than this, the best option is a transconjunctival ligament release and fat transposition. This also requires a true expert that does it quite frequently.

What can be done to correct my lower eyelids? (photos)

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