Am I A Candidate For Blepharoplasty For Bags and Hollowness? (photo)

I'm a 29 year old male with under eye issues. Around the age of 18 I began to develop bags under my eyes that in some light appear to be hollow or white. I've tried restalyne twice, with little success. I think the restalyne would be affective for me if I were injected with a very large amount, but I cant justify paying every 7 months. Recently I've seen two surgeons who've recommended a transconjunctive blepharoplasty, but I worry that my eyes will just become more hollow. Thanks

Doctor Answers 17

Blepharoplasty for a young man

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You have excess fat bulging through the medial and middle orbital septum.

Your surgeons' recommendation of a lower lid blepharoplasty is a good one.

There are two approaches -

  1. transconjunctival that trims the excess fat from inside the lid.
  2. Standard blepharoplasty that uses an incision under the lashes. This allows full release of the orbital septum, very careful trimming of the excess fat so it lies smooth with the muscle and re-positioning of the remaining fat.

Either approach is acceptable. The better one for you depends on a face-to-face examination. Discuss the pros and cons with the surgeon you select to help you. Best wishes.

Concerned with the lower eyelids

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Your concerns are justified. As a general rule, the hallmark of healthy, young looking lower lids is fullness.  Overall, you do have a congenital lack of lower lid fullness, meaning that if anything is done to the lower lids you need to be very careful about creating a hollow look. Unfortunately, while you do have an overall lack of fullness, you also have a small area of fat that projects forward in your lower lids causing a tired look. Filler has been unsuccessful because you are not only trying to add volume but are also trying to camouflage the puffy areas. A transconjunctival lower lid blepharoplasty would remove the small amount of protruding fat (the puffiness you see on the pictures) through an incision on the inside of the eyelid. This would cause the lower lids to be smooth without creating a visible scar. This surgery makes sense but would have to be done VERY conservatively in order to cause the lid to be flat, not hollow. Following the surgery, a very small amount of filler (1 syringe should be plenty for both eyes) could then be used to add the little bit of volume needed to give the lids a nice youthful appearance.

Michael R. Menachof, MD
Greenwood Village Facial Plastic Surgeon
4.4 out of 5 stars 28 reviews

Blepharoplasty for bags under eyes

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Removing the fat in the lower lids creates more of a natural contour with both muscle and skin without the puffiness present.  A lower blepharoplasty is performed under a brief general anesthetic as an outpatient procedure.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Fat repositioning

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Fat repositioning would be a better option for you than simply excising and removing the fat. In addition, I have often used fat grafting to the eyelid cheek junction to help further camouflage the eyelid fat. This technique is much more advanced and extreme care has to be taken to avoid creating additional lumpiness. It has to be subtle amount of fat added.

If you decide to explore this further, I would recommend consultation with an ASOPRS trained Oculoplastics surgeon. You can find one close to you on the ASOPRS dot org website.


A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 42 reviews

Lower Eyelid Surgery for Under-Eye Bags

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Fixing the problem with the puffiness below your eyes by "masking" with Restylane filler is a temporary solution and you seem to be looking for a more permanent fix. You may be a candidate for lower eyelid surgery should you elect to have the fat removed surgically. Because hollowness is also an issue, you may want to do a comprehensive procedure in repositioning fat. As an oculofacial cosmetic surgeon in New York for over 15 years, I strongly recommend you consult with a qualifies doctor who understands your goals and can give you natural-looking results from blepharoplasty.

Amiya Prasad, MD
New York Oculoplastic Surgeon
4.4 out of 5 stars 80 reviews


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Yes, it appears that you do have some herniated fat.  Sometimes releasing the ligament along the lower lid during a transconjunctival( inner lid incision) blepharoplasty can improve this area as well. The tear trogh area can be difficult to soften without  filler.  Good luck.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Balance avoids hollowness after blepharoplasty

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When it comes to blepharoplasty, it is about balance.  More is not necessarily better.  The goal of transconjunctival blepharolplasty is to reduce bulging fat in the lower eyelids.  Removing too much fat can produce hollowness but an experienced surgeon will be able to balance the amount of removal to avoid this.  That being said, traditional blepharoplasty does not improve the tear trough or demarcation line between the lower lid and cheek skin.  Advanced techniques can help with this but add to recovery time.

Lawrence Bass, MD
New York Plastic Surgeon

Blepharoplasty for lower lid bags

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A transconjunctival lower eyelid blepharoplasty would be ideal as you have good lower lid skin tone, just inherited bags of fat coming forward from the eye socket.  Repositioning some of this fat into the tear trough would create a very youthful contour to the mid-face.

Matheson A. Harris, MD
Salt Lake City Oculoplastic Surgeon
5.0 out of 5 stars 6 reviews

Transconjunctival lid rejuvenation is the answer

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Familial or inherited bags in the lower lids will respond very well to a tranconjunctival blepharoplasty, and if done well, future lid hollow can be avoided. The 'hollow' that you see is due to overhead light and shadow which accentuates the bags. Women will mask things with cosmetics, but men can't bother.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

Blepharoplasty at age 29

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I am in total agreement with the other consultants who have advised a transconjunctival blepharoplasty with fat repositioning. I've been doing the procedure for many years and have very happy patients. Just make sure you have a surgeon that is quite experienced in the technique, as not all surgeons use this approach.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 29 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.