Lower eyelids look ok & tired, age 46, what's the best eyelid surgery for my situation? (Photo)

Question

I‘m 46 year old and my lower eyelids let me look old and tired. What is the best surgery technique for best results?

Kenneth D. Steinsapir, MD · Answer

The best surgical option for this is transconjunctival lower eyelid surgery with arcus marginalis release. This rotates the lower eyelid pillows into the hollow area under the eyes. I would be very careful to avoid surgery performed through the skin as this is associated with lower eyelid retraction. A very good alternative to surgery for you would be under eye filler. The challenge is that you need an injector who really knows what they are doing and those type of clinicians seem to be in short supply.

Donald B. Yoo, MD, FACS · Answer

Common reasons for lower blepharoplasty include tear trough deformity or pseudoherniation of the orbital fat. An in-person exam would provide a more accurate diagnosis, but preliminarily based on your photos it does appear you have pseudoherniation of fat creating "eye bags.” They should also be more prominent when you look up. Transconjunctival lower blepharoplasty with fat repositioning will provide nice results and a better lid-cheek transition in this case. @drdonyoo

Bianca Knoll, MD · Answer

Thank you for posting your question. Looking at your picture, it seems you have taken well care of yourself. The skin looks very nice, and appears young. A lower blepharoplasty using a tranconjunctival approach (incision from the inside), an arcus marginalis release, and repositioning the  protruding fat compartments will result in a natural appearance. Some patients opt for an additional blending using regenerative lipofilling, containing many of your own regenerative cells and stem cells. An improvement of the overlying skin texture can be overserved over time. We found this approach superior to some other alternatives, since it preserves important anatomical structures, restores your anatomy, and uses no foreign, artificial material like fillers. The downtime and swelling is acceptable.Somewhat more, than with non surgical treatments, but certainly less than more involved lower blepharoplasty techniques. I hope this helps you to find a good solution.

Jason Emer, MD · Answer

For puffiness and sagging under the eyes, we often use Renuvion helium plasma radiofrequency energy to achieve incredible results and take years off of your appearance. Combining RF energy and cool helium plasma, the signs of aging (wrinkles, pigmentation, skin laxity) are improved in a ‘Nonsurgical Eyelid Lift.' The focused heating tightens and peels the upper layers of skin with extreme precision, leaving the surrounding area undamaged, smoothing and tightening the periorbital skin, and improving the overall skin quality around the eyes. It's an aggressive treatment, and the recovery time is longer than with other nonsurgical procedures, but the results can be life-changing.​ See an expert to determine if this is the best solution for you. Best, Dr. Emer

Jonathan Kulbersh, MD · Answer

Thank you for your question and photo. You are likely a candidate for a lower blepharoplasty procedure to give your eyes a more youthful and awake appearance. This minimally invasive surgery can smooth the transition from the lower lid to the upper cheek by removing excess skin and fat, or sculpting and repositioning fat as needed. 
By contouring and restructuring the lower lid, the eyes can appear more open and refreshed with results lasting up to 10 years or more. I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon. They’ll be able to better assess your concerns and suggest the best treatment plan to ensure you achieve your aesthetic goals.

Sam Speron, MD, FACS · Answer

This is a common question.  Horizontal eyelid wrinkles and sogginess 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. A mini facelift or midface lift is another great option for many people to correct malar bags and other signs of aging around the eyelids. 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, there are no scars behind the ears and you can wear your hair up anytime 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.

Nelson Lee Novick, MD · Answer

You"re young. So, before jumping into expensive and aggressive surgery, you may wish to consider the use of an appropriately robust HA filler treatment for the upper cheeks ( the supports for the infraorbital regions), which a relatively simple, relatively inexpensive, nonsurgical, little-to-no-downtime, approach to treating under eye bags and tear troughs, as well as improving the facial contour. As a "polishing" step, if necessary, a cohesive, low viscosity HA filler, can be used directly under the eyes for additional improvement. Make sure to consult with a board certified cosmetic dermatologist and ask to see his/her personal befores and afters before agreeing to proceed. Best of luck.

Mehryar (Ray) Taban, MD, FACS · Answer

You appear to be good candidate for scarless lower blepharoplasty. Technique is important to preserve eye shape and function with natural results. See an expert.

Justin K. Williams, MD · Answer

It is common for men and women to have fullness in the lower eyelids as they age. This can get worse throughout the day or with different seasons and even with allergies. There are nonsurgical options for treating discoloration, however the "bags" that we commonly see on her eyelids are usually due to fat that is stretching the structures associated with the lower eyelids. A common technique we use for patients like you is a trans-conjunctival lower lid blepharoplasty. In this, a small incision is made on the inside of the eyelid, fat is removed from this area, and the incision left heel on the inside without any external scar. 
People of older age than yourself sometimes develop excess skin and in extreme cases of these, excess skin is needed to be removed. A young patient like yourself is likely to do very well with just fat removal or re distribution using the above-described technique. This is a common procedure that we do in our office. Please see the attached link for more information on this topic.