Would I be a candidate for a lower bleph or would I need a mid face lift or more conservatively just injectables?

Question

My under eye has always bothered me but now at 42 it’s more pronounced. I tried ez gel under the eyes but results only lasted a few months. Not sure if I should consider a lower bleph or would need a mid face lift.

Young Min Im, MD, PHD · Answer

As we age, facial volume tends to descend and decrease over time, while the skin also gradually begins to sag.
From your current photos, we can see volume loss, tissue descent, and skin laxity all together.
To improve the hollow tear trough area and the bulging above it, we would recommend lower blepharoplasty. In addition, because the downward descent is quite noticeable, we would also recommend a midface lift using the lower eyelid incision from the lower blepharoplasty. This allows the descended tissues to be lifted vertically upward.
As a result, the heaviness and bulging appearance above the nasolabial fold can also be improved, while addressing the under-eye hollowness more effectively.
Even improving just the under-eye area can make you look much fresher and less tired.
Under-eye surgery generally has a very high satisfaction rate, so we would recommend considering Lower blepharoplasty together with a Midface lift.

Andrew Miller, MD · Answer

For the lower lid area, you have both excess fat bags which can be reduced with blepharoplasty. You also have a tear trough deformity which is nicely treated with fat transfer at the same time. This can be combined with a subperiosteal cheeklift to help the midface at the same time. Be sure to see a facial specialist with pleny of experience with midface lift.

Kadir Berat Oyur, MD · Answer

At 42, your concerns with the under-eye area are driven by a combination of mild lower eyelid fat prolapse (eye bags) and early structural volume loss along the midface and nasolabial regions, which is why temporary injectables like EZ Gel only provided short-term improvement. Looking at your anatomy, my suggestion is a transconjunctival lower blepharoplasty combined with micro-fat repositioning or grafting; this will seamlessly flatten the under-eye bags and fill the tear trough without leaving external scars or creating a hollow appearance. While a comprehensive midface lift is likely premature for your current skin elasticity, coupling the lower blepharoplasty with a conservative deep-plane midface rejuvenation or targeted fat transfer will beautifully lift the cheek profile and soften the nasolabial folds. An in-person consultation remains the essential next step to physically evaluate your tissue laxity and design a definitive surgical plan tailored to your facial structure.

Gary M. Horndeski, MD · Answer

I recommend you begin with a lower blepharoplasty with fat transposition to fill out the hollows.  After this is done, you can consider if you need a mid facelift.

Best Wishes,

Gary Horndeski, M.D.

Zoran Potparic, MD · Answer

It is not possible to give you good advice about face lift based on these photos that do not show much of your face? There is no doubt that lower blepharoplasty with periorbital fat grafting would be good procedure for lower eyelids but it is questionable whether midface lift would have any role. Considering mild jowls and face laxity one should consider lower face, possibly neck lift as a better solution. It would be in your best interest to discuss this with a board certified plastic surgeon with good reputation in facial rejuvenation. Good luck.

Carl Truesdale, MD · Answer

This is one of the most common consultation questions and the answer hinges on identifying which specific anatomic issue is driving your concern.
Lower blepharoplasty addresses:
Bagging from herniated lower lid fat pads.
Mild excess lower lid skin.
Tear trough hollowness (via fat repositioning technique).
Best candidate: patient with visible bags, dark shadows from a hollow trough, or both. Skin quality intact.
Midface lift addresses:
Descended cheek pad (the malar fat pad has dropped).
Deepening of the lid-cheek junction.
Loss of structural cheek support.
Often combined with lower bleph.
Best candidate: 50+ patient with visible cheek descent, where the lid-cheek transition has lost its smooth curve and now shows a stepped or hollow appearance. Younger patients rarely need this.
Injectables (filler) addresses:
Tear trough hollowness (deep medial placement).
Anterior cheek deflation.
Camouflage of mild contour issues.
Best candidate: any age with mild-to-moderate concerns who isn't ready for surgery, OR as a 'preview' of what surgical correction might look like.
How to figure out which you need:
In a mirror, do these tests:
Look up while your finger lifts the cheek pad up about 5mm. If this corrects the appearance, you need a midface lift (or filler that lifts the cheek).
Look up while your finger fills in the tear trough. If this corrects the appearance, you need filler or fat grafting to the trough.
Pinch your lower lid to see if a discrete fat bag is present. If yes, lower blepharoplasty is needed (likely with fat repositioning).
Combinations are common. Patients in their 50s often need both lower bleph AND midface lift to address all the components. Patients in their 30s to 40s often do well with bleph alone + filler in surrounding areas.
What I'd avoid:
Multiple rounds of filler without considering whether surgery would be more durable.
Lower bleph alone in a patient with significant cheek descent &mdash; leaves the malar mound prominent.
Midface lift in a young patient without cheek descent &mdash; overcorrects and creates an unnatural look.
Best move: in-person consult with a surgeon who does all three. Ask them to demonstrate the finger test in front of the mirror with you. The right answer should be visually obvious.

Darryl J. Blinski, MD · Answer

Based on the close-up photos would recommend virtual consultation to better see the full face, but based on what is seen, I would recommend a lower lid blepharoplasty with removal or repositioning of fat pads. In addition, I would recommend a facelift with SMAS plication and combining with Endo laser. The fee for those procedures is $10,000-$20,000. Best of virtual consult with.

Would I be a candidate for a lower bleph or would I need a mid face lift or more conservatively just injectables?

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