Under eye circles - hollows, slight bowling of lid. What would bprovide the best results? (Photos)

Question

I’ve had three consults one Dsaid fat transfer, another said lower bleth + fat transfer. The doctor I like best suggested a lower Bleth with fat repositioning with stitch to the lower corner. When he showed me what this would look like manually, I was very pleased, but I am concerned that it will not fill the hollows under my eyes I’ve always liked fillers in that spot, but I don’t hear people doing it very much these days and since I’m getting a facelift, it makes sense to have the surgery on my eyes. I would appreciate if a doctor could give me a recommendation based on my photos.

Lexie Wang, MD · Answer

I agree with the surgeon that said lower bleph with fat grafting. The lower bleph will address the excess fullness you have in the "eye bag" but the fat grafting will address the hollowing, akin to filler.

Yongwoo Lee, MD · Answer

Thank you for sharing your photos. Your main concern is the hollow, not only bags, so I would not rely on fat repositioning alone. A reasonable plan could be a lower blepharoplasty, either transconjunctival with a small skin pinch excision or through a subciliary incision, combined with micro fat grafting along the tear trough and lid-cheek groove.
Lateral canthal support, such as a canthopexy, is also important to help prevent ectropion, especially with thin skin and a flat midface. If it is combined with your facelift, the midface lift also helps support the lower lid.
Since you have had fillers in this area, any remaining filler should be dissolved first, and the area reassessed after a few months once it has returned to baseline. The dark pigmentation may still be visible after surgery and might need skin treatment.
Dr. Yongwoo Lee, VIP Plastic Surgery Korea

Gary M. Horndeski, MD · Answer

At the time of facelift, a lower blepharoplasty can be done. At that time, fat can be repositioned to fill it out as well as at the time of facelift the cheek fat can be brought up higher. I do not recommend fillers.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Zoran Potparic, MD · Answer

It looks like serious volume(fat) loss is happening around your eyes. Volume replacement with fat grafts, transposition of fat flaps from lower eyelid (minimal in your case) and lower transconjuctival blepharoplasty would be a good choice to make significant improvement. Good luck.

Nelson Lee Novick, MD · Answer

From the photos provided, there appears to considerable volume loss in the cheek regions. Since the cheeks provide support for the under-eyes and lift for the midface below, it is likely that the use of a robust HA volumizing filler, properly injected in the hands of an experienced, board certified cosmetic dermatologist filler expert would not only address the hollows under the eyes, but provide a more youthful contour to the cheeks and diminish the smile folds below. Before jumping to expensive, aggressive surgery or even to minimally invasive fat injections, you would be wise to consult with an expert filler injector who would be able to manually manipulate your cheeks to simulate filler treatment to give you a better, real-world idea of the potential outcomes of this nonsurigical approach. Treatment typically should take no more than ten to fifteen minutes to perform and usually engenders little to no significant post-treatment downtime.  Hope this helps and best of luck.

Under eye circles - hollows, slight bowling of lid. What would bprovide the best results? (Photos)

Answers (5)

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