Do I have festoons or just hollow under eyes and will a lower blepharoplasty be the best option for me? (photo)

Hello and thank you for your question. A formal evaluation would be needed to determine the best treatment. There are both surgical and non-surgical options to correct this, depending on your specific situation.

For less significant puffiness and sagging UNDER the eyes, or more mild improvement, there are nonsurgical treatment options: we often use Renuvion helium plasma radiofrequency (RF) 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 Lower Eyelid Lift.' The focused heating tightens and peels the outer skin layer 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.​

Surgery (a lower blepharoplasty with or without canthopexy/canthoplasty or orbicularis muscle suspension) is a great option for more significant improvement- for example if there are more severe lower eyelid bags / bulging present. Sometimes the surgery can also be used to intentionally adjust the shape and/or size of your eyes, or correct any asymmetries!

Dr. Donald Groves is an expert facial plastic surgeon that I work with, who specializes in these types of procedures. It is important that if you are considering surgery that you go to someone who is well trained and very experienced with these delicate operations to get the best results. I suggest getting a consultation with an experienced cosmetic dermatologist and facial sculpting expert, or an aesthetic facial plastic surgeon like Dr. Groves; we are both located right here in Los Angeles.

Best,
Dr. Emer

You have hollow eyes and they are not festoons. You would need a lower blepharoplasty to correct them.

Best Wishes,

Gary Horndeski, M.D.

A full set of eyelid pictures from all angles are required to make a determination about how best to proceed. From the one very limited photograph, there does not appear to be festoons. The primary goal for lower eyelid surgery is to remove fat bags, creating the puffy look through a trans conjunctival approach on the inside of the lower lids. When there's excess skin present, a pinch technique of the excess skin can be performed, which is usually on patients over 50 years. The coloration of the skin does not change with a blepharoplasty.

That area can be a bit complex to assess because there are a lot of variables that contribute. It doesn’t look like you have fully developed festoons, but you might have the beginning of them.
There may also be a slight malar edema (poorly understood and difficult to treat) and it looks like you have some age related volume loss of volume in the tear trough area.
It would be helpful if you could include a complete set of facial pictures.
Look at how plastic surgeons take before and after pictures to get an idea.
To get a more accurate assessment, I suggest a few in person consultations with the plastic surgeons in your community.
Best,
Mats Hagstrom MD