At 27 am I too young for a lower blepharoplasty? Will it cause scleral show down the road as I age? (Photos)

I've had huge under eye bags since I was a baby. My dad and grandmother have them also which make me think it's genetic. For years people have asked me if I'm tired even though I get plenty of sleep. I feel like they age me so much and they are the first thing I notice when someone takes a picture of me. It has bothered me for years and makes me very self conscious. A few years ago I finally went to a doctor for restalyne fillers but was told I'm not a candidate and would need surgery.

Doctor Answers 15

Eyelid surgery

Dear XGLM89X,

From the look of your photos you would be a very suitable candidate for lower eyelid surgery.  At your age this is best performed via a transconjunctival approach.  The fat bags from this approach can be re-draped into the trough although it is often quicker and simpler to do a transconjunctival resection of fat with fat micro injections to the tear trough.

Regards,

Dr Nettle

At 27 am I too young for a lower blepharoplasty?

Thank you for your question and photo. No, you are not too young for a lower lid blepharoplasty. Without the benefit of an examination, I expect you would need the incision through the inside of the lower lid, called a transconjunctival incision. You problems are, as you know, the pseudo-herniated fat pads in your lower lids, called by some, bags. This creates a shadow under the bags or "dark circles." Other than this you appear to have a gorgeous face.  I think you should go for it. It can be done under local anesthesia and the recovery time isn't very long. 

No, it shouldn't cause or prevent any scleral show in later years.

Best of luck to you.

Lower Blepharoplasty

Clearly what bothers you is the appearance of dark circles beneath your eyes.  On occasion, this is due to pigment of the skin.  Much more frequently though is the dark circles are due to shadow.  There a 2 causes for shadow beneath the eye; bulging fat which is your main concern because it casts a shadow below it.  You also have a hollow beneath the bulging of fat, a thinning of the tissues over the bone.  All the surgeons commenting are correct, even though their approaches are different.  No matter the approach though, one has to address the fat bulge and or add some filler to the valley beneath.  Both issues can be addressed by removing the fat from the area of bulge, this is done with a transconjunctival approach,  and therefore the muscle that supports the lower lid is never touched.and cannot weaken the lid or have it pull down.  Also, a fat graft of an appropriate amount  to the valley beneath.  I hope you find this information helpful.

Thomas Hubbard, MD, FACS
Virginia Beach Plastic Surgeon
4.9 out of 5 stars 32 reviews

Blepharoplasty

Thank you for your question. You certainly seem like a candidate for fillers as fillers may be a suitable procedure for the first attempt at improving the dark bags under your eyes. Fillers are temporary and can provide you a "test drive" with the improved aesthetic appearance you desire. I suggest that you move forward and consult with a board certified facial plastic surgeon.

Best wishes,


Ross A. Clevens, MD
Melbourne Facial Plastic Surgeon
4.7 out of 5 stars 96 reviews

Transconjunctival lower blepharoplasty will not cause sclera show

Lower blepharoplasty can be done very safely using transconjunctival approach without causing any scleral show or lower eyelid retraction. See following video and link. See an oculoplastic surgeon.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 62 reviews

Eyes

You are not too young for a blepharoplasty, which could improve the appearance you desire. However, a less invasive treatment would be dermal filler like belotero. I would recommend getting an evaluation to determine what would work best for you.

Too young for lower blepharoplasty?

Hello.  Thank you for your question.  You are not too young for a lower blepharoplasty.  However, you may be able to benefit from a more conservative approach by using a hyaluronic acid filler (Restylane) to fill in the tear trough and smooth the transition from the eyelid to the cheek.  This would provide only temporary improvement and would likely need to be repeated in 9 - 12 months to maintain the result.  If you were to consider a longer lasting approach, I think that a transconjunctival lower lid blepharoplasty with fat repositioning or fat transfer to the tear trough may be a good option for you.  The transconjunctival approach has very low risk of scleral show or rounding of the lower eyelid.  I would suggest that you seek a consultation with a board-certified Facial Plastic Surgeon or Oculoplastic Surgeon with extensive experience and expertise in facial rejuvenation to allow them to assess your individual anatomy, concerns, and goals, in order to determine the best treatment plan for you.  I hope that this information is helpful.  I wish you the best in achieving your aesthetic goals.

Michael Boggess, MD
Nashville Facial Plastic Surgeon
4.8 out of 5 stars 33 reviews

Lower eyelid folds

 A distinction needs to be made as to the cause of the fullness of the lower eyelids. There are in fact three factors at work here. It can be seen by the evolution of the fullness in the excellent photographs of the patient. At an early age many times the fullness is due to the pretarsal orbicularis muscle. This is distinguished by accentuation with smiling and is immediately below the lash line. As a person ages this is aggravated by increasing herniation of the periorbital fat. This can be seen in this patient's age progresses and especially in the last photograph. Herniated fat usually requires removal and I strongly favor the trans conjunctival removal which is safer than the transcutaneous or external incision. Finally the tear trough or nasal jugal groove can be filled with filler material such as hyaluronic acid. All of these procedures carry with them benefits as well as risks which should be discussed extensively with your plastic surgeon. The risk of scleral show or exposure as a person ages is related to a number of factors, the greatest one being congenital or inherited tendencies.

Richard O. Gregory, MD
Orlando Plastic Surgeon
5.0 out of 5 stars 11 reviews

What you risk with surgery is permanent damage to your appearance if the work is not performed correctly.

70% of my surgical practice is fixing the work of other surgeons, so I know what I am talking about.  There is no question that a properly done hyaluronic acid filler will correct this and the result will be much better than any surgery.  That is why the fillers are so popular.  Yes treatment is not permanent but the effects last over a year.  It is much more predictable than surgery and can be reversed with enzyme if it is not right. Look for a high experience injector for this service.  It is fussy and you are asking the injector to sculpt your face.  I seen patients who fly into Los Angeles for service from all over the world including Boston so I know finding the right injector is challenging.  Remember, when a surgeon says you are not a candidate for something, that might be true or they might simply be telling you that they can't accomplish what you are looking for, or more darkly, that they make more money selling surgery.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
4.9 out of 5 stars 23 reviews

Never too young

You are not too young for correction of something that bothers you this much.  It is difficult to tell if you would do best with injections (temporary) or surgery (semi-permanent) from photos alone.  But it is easy to say that now is as good a time as ever.  Eyelid surgeries can make a big difference with minor pain.  Go see a board certified plastic surgeon or oculoplastic surgeon.  You are too pretty to let those bags get in your way!

James D. Frost, MD
Pensacola Plastic Surgeon
4.9 out of 5 stars 10 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.