Blepharoplasty for Puffiness Below Under Eye Area?

I have some puffiness not directly underneath my eyes, but a bit lower. Would this be corrected with Blepharoplasty? I can't seem to find before and after pictures of this type of surgery. Am I looking under the wrong procedure?

Doctor Answers 14

Puffiness below the eyes

Puffiness below the eyes can be do to a muscle roll, a fat bulge, or cheek irregularities (or a combination of these). A muscle roll may warrant muscle roll tailoring. A fat bulge may warrant transconjunctival blepharoplasty or fat repositioning surgery. Cheek irregularities may warrant cheeklift procedures, cheek augmentation / volume readjustment procedures. All may benefit from volume addition by various grafting techniques.

Consultations with board certified plastic surgeons can guide you through all of these procedures and help you decide which is best for you, and which doctor's plan most suits your needs.

Beverly Hills Plastic Surgeon
4.9 out of 5 stars 178 reviews

Lower eyelid rejuvenation options for treatment

You would be a candidate for a  lower eyelid  blepharoplasty.    If you have herniation of orbital fat causing bags of the lower lids with lack of soft tissue fullness.  These features can be corrected with a lower eyelid blepharoplasty with fat repositioning.  An accurate diagnosis of the problem is essential.  .  If the condition is only lose skin then you may want to consider SmartSkin or  SmartXide microablative fractionated CO2 laser resurfacing.   A consult would be needed to advise you which procedure would meet your expectations.  Other choices would include soft tissue fillers such as Juvederm.

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 19 reviews

Lower blepharoplasty

A lower blepharoplasty is performed for the fat bags directly underneath the eyelids. The other goal of lower blepharoplasty is to conservatively tighten a small amount of excess skin in the lower lids. The malar fluid bags or festoons are not corrected with a blepharoplasty surgery.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 145 reviews

Sagging of Orbicularis Oculi

Often times the muscle around the eye sags and this forms the crescent shaped swelling below the eyelid crease.  Also if you are a smoker you can acquire malar edema in this area.  All surgeons have difficulty in correcting this area completely regardless of their training and experience.

Richard D. Gentile, MD
Youngstown Facial Plastic Surgeon
4.4 out of 5 stars 36 reviews

Malar Bags

I agree with the others that it's difficult to tell without a picture but the only logical thing it could be , if truly not the lower lids, is malar bags.  Although it's a small picture you seem too young for these.  A difficult problem to fix so visit several plastic surgeons in your area.

Christopher L. Hess, MD
Fairfax Plastic Surgeon
4.4 out of 5 stars 34 reviews

Difficult situation.

It is best if you provide a close-up picture of your eyes so we can give you more specific advice. However, there are many conditions that can lead to your concern. These include excess skin, herniated fat, or localized tissue swelling. All three conditions require different approaches. If you visit a qualified surgeon for an evaluation, they most likely will be able to help you. Good luck.

David Shafer, MD
New York Plastic Surgeon
4.9 out of 5 stars 77 reviews

You probably have malar bags.

Hi!  It sounds like your problem is in the upper central cheek just below the lower eyelids. This is difficult and definitely not corrected by blepharoplasty.  In fact, blepharoplasty can make malar bags worse.

I usually do a mid facelift through the mouth for this problem.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
4.8 out of 5 stars 9 reviews

Volumizing your face with fat or fillers, lower blepharoplasty

Bags under the eyelid can be from many things including protruding fat from under your eyes, the muscle surrounding your eye could be drooping over your smiling muscles, and it can most likely be a loss of volume under your eyes. As you and everyone ages, you lose volume from your whole face including where your cheeks are under your eyes.

Lower blepharoplasty involves removing fat from under your eyes, and also sometimes involves removal of skin. This procedure can make you look better but many times it doesn't fully make you look younger and better. Volumizing your face can do a lot to make you look younger and better. This can be done with fat and other fillers. A midface lift can also help but, again, this may not make you look naturally younger and better.

The best way to fully learn more about this is to come and see us for an evaluation. It is always good to visit a board certified Facial Plastic and Reconstructive Surgeon when it comes to your face. We specialize in the face!

Philip Young, MD
Bellevue Facial Plastic Surgeon
4.2 out of 5 stars 86 reviews

Consider a personal assessment by a fellowship trained oculoplastic surgeon.

Dear Angelica:

There is really no such thing as an average lower eyelid. Lower eyelid surgery needs to be adapted to the actual issues. You have not provided a close up photo, so it is difficult to know precisely the physical basis for your concerns. Generally, the major change that occurs in the lower eyelid is a descent of the cheek fat.

When we are young, the cheek fat extending into the lower eyelid where it blends into the lower anterior orbital fat pads. This contributes to fullness at the top of the cheek extending to the lower eyelid crease. In time the cheek fat drops exposing the lower eyelid fat. This is the fat that is removed in classic lower eyelid surgery.

The falling cheek fat also leaves the under eye area hollow. There is a system of connective tissue responsible for hold the cheek fat. Some of these give way more than others and this contributes to the appearance of folds or bags at the top of the cheek and this is likely what you are describing. There are a number of options for addressing this type of problem.

Regarding who is best to address these concerns, opinions will vary depending on the specialty of the surgeon you are hearing from. However, be aware that there is only one surgical specialty whose primary focus is the eyelid and midface, and this is oculoplastic surgery.

Look for an oculoplastic surgeon who is fellowship trained and has been elected to the American Society for Ophthalmic Plastic and Reconstructive Surgery. This will mean that the surgeon is board certified in ophthalmology and has completed a two-year fellowship in eyelid and midface surgery. Compared to other surgical specialists or generalists like a general plastic surgeon, these individuals are extensively trained to address eyelid and midface issues.

There are a number of these highly qualified surgeons in New York. You can find these individuals by going to the website for the American Society for Ophthalmic Plastic and Reconstructive Surgery and using the membership directory.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Lower eyelid and cheek swelling after Blepharoplasty

You may want to look up the term malar bags or malar festoons. Midface lifts or SOOF lifts as well as orbicularis oculi suspension techniques have been described for management of this. Conditions which result in worsening of this are termed Blepaharochalasis. Occasionally, this is aggravated by thyroid conditions.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 82 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.