Almost 40 - Too soon for blepharoplasty? (photos)

Question

I'm almost 40 and I don't know if I am a good candidate for blepharoplasty yet or if an excellent result could be achieved with something less invasive like a laser. My skin has become more crepey and I have bags, though they are not fatty and puffy. Filler in my tear trough seems to look puffy (some days, not always). I've read so many things that seem to contradict. I would be grateful for a clear treatment plan. Thank you

Zachary Farhood, MD · Answer

It is hard to fully assess you without looking at multiple views, however it would not be unreasonable to consider a lower blepharoplasty (options could include skin pinch, fat removal, fat repositioning). Laser resurfacing would be a great option to improve the crepey quality of your skin.

Jonathan Kulbersh, MD · Answer

Thank you for your question and for providing photos. You would likely benefit most from a lower blepharoplasty to reduce wrinkles and sagging below the eye. This minimally invasive surgery can smooth the transition between the eye and upper cheek by sculpting, repositioning, or removing excess fat as needed. 
This results in a more youthful and refreshed appearance that is known to last for around 10 years or more. I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon who can assess your concerns and suggest the best course of action.

Peter Chang, MD · Answer

Thank you for your question and photos submitted. Based off your information provided, you seem to be a great candidate for a lower blepharoplasty. This will help remove the excess skin that is causing the crepey lower lid appearance. This will give the undereye an overall rejuvenation. You can expect bruising, swelling, and sutures/dressings for about 1-2 weeks depending on the procedure techniques and physicians post-surgical guidelines. The next step to take would be finding a qualified and experienced Board Certified plastic surgeon to do a full evaluation and provide you with a designated treatment plan to reach your desired goals.

Sam Speron, MD, FACS · Answer

This is a common question.  Upper eyelid hooding 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.

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 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.

I hope this helps answer your question. If it does, please take a moment to up vote this answer on the “respond” button on the top right.

Janet Woodyard, MD · Answer

It is impossible to tell from the photos which treatment would be best for you. There are many ways to treat the under eye area and an in person consultation with a board certified plastic surgeon would be my best recommendation for you.  It is unusual though to perform lower lid blepharoplasty without an upper lid bleph. Best wishes.

Nelson Lee Novick, MD · Answer

I share your concern about the direct use of a filler into the tear troughs when there is an apparent volume deficit in the upper cheek regions. The upper cheeks serve as the support for the under eye regions and when there is a volume deficit in the cheeks, as seems to be the case here, the inevitable result is the development of tear troughs and under eye crinkles and wrinkles. An appropriately robust HA filler to cheeks can not only restore a more feminine, heart-shaped oval to the face, but will likely improve the under eye issues without the need for any direct injections there. If still necessary, superficial peels can then be used under the eyes for further improvement of any residual crinkling. Make sure to consult with a board certified cosmetic dermatologist and check out his/her personal befores and afters prior to agreeing to proceed. Best of luck.

Kenneth D. Steinsapir, MD · Answer

You are only going to get generic advice from a forum like this especially with the images you have provides. I suspect that a big part of your issue is poorly done lower eyelid fillers that actually make your issues worse. Microneedling does very little. I also suspect that you have poor lower eyelid support which will put you at risk for complications from lower eyelid surgery. That does not mean that you can't have lower eyelid surgery. It means you should only have it if it is absolutely indicated and that can't be determined  without an in person assessment. Assessing your lower eyelid tear trough filler treatment is a first step.

Marc Polacco, MD · Answer

Thank you for your question. For skin surface issues, typically microneedling or laser resurfacing are great for tightening the skin and remodeling collagen. If lower lid fat pads are a contributing factor, then a lower blepharoplasty may be indicated. I often combine a lower bleph with laser resurfacing in many patients. Lastly, I wouldn't worry about age at all! Much of eyelid aging and/or heaviness is genetic, and I've performed eyelid surgery for patients as young as late 20s in appropriate candidates. I hope this information is helpful, and all the best to you.
-Dr. P

Carrie L. Morris, MD, FACS · Answer

I do appreciated some degree of crepiness of your lower eyelids. I also see the fullness, although mild, that you are talking about. An appropriate surgical candidate for a blepharoplasty has to do with the condition that is present rather than age. It is actually best to have surgery earlier in life, since it is often less complicated, which means less down time, less surgical risk, and less money! Also you are able to enjoy the results longer during the prime of your life. The duration of results for a lower blepharoplasty is about 25 years.

David M. Kowalczyk, MD, MBA, FACS · Answer

Hi there! A blepharoplasty for the lower eyelids can work very well to address fat and crepe-paper skin. To remove skin, a subciliary or below the eyelash approach would be best. A certain amount of skin is removed to help improve tone and texture. You can avoid surgery at this point, though, and it may be recommended. CO2 laser can help to refine the surface of the lower eyelids and tear trough. Being careful not to be too aggressive is very important. Topical creams which help to stimulate collagen may be good as well. Hope this helps!

Almost 40 - Too soon for blepharoplasty? (photos)

Answers (12)

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