Blepharoplasty combination approach for under eye bags? (Photos)

The eye area needs significant combinations to get improvement. Lasers like erbium, co2, halo, profractional/contour, or Fraxel can all be used to build collagen long term. Plasma pen is a newer less invasive option but will take many treatments and require proper skincare. Plasma Pen is focused electrical plasma energy to tighten skin, producing small columns of energy just above the skin, allowing the skin to tighten to help improve wrinkles. This area will have 3-5 days of small “dots” that will then scab and peel, then the skin will tighter and brighter after. Numerous treatments are needed over lasers where only one or two give a bigger result, but more downtime. After plasma pen you NEED peels 2 weeks like later Cosmelan, enlighten or aerify, see emeragecosmetics (link). At home derma rolling should be started weekly even after plasma pen or lasers to further increase collagen, see emeragecosmetics AERIFY x anteagemd stem cell ampules. To properly heal you need light Stim red LED, EmerageSkin refit face, refit eye; AnteageMD serum, silagen silicone gel, jan Marini bioshield, EmerageSkin enzymatic polish, and EmerageSkin hyla b and AOX, and Sente dermal repair. Otherwise there is EXTREME risk of pigmentation issues and “dots” in the treatment area. at home peels like cosmelan, enlighten and aerify along with dermarolling (AERIFY emerageskin roller with Anteage MD ampules) should be started now regardless for antiaging, sun damage, and wrinkle prevention. There are many things you can do to treat under eye hollows and dark circles. A surgical option to remove skin and/or fat will such as eyelid blepharoplasty with or without fat pad repositioning (if doing lower eyelid surgery) will be the best long term. There are many things you can do to treat under eye hollows and dark circles without surgery. Non invasive less downtime options such as fillers, lasers, microneedling/PRP, cosmelan peels, and microneedling RF like Fractora, PiXel8 or morpheus can all help give some improvement. Accutite can often be used or stronger lasers like erbium or co2 spot treatment can tighten the skin and give very quick improvement in wrinkles and texture. I suggest you get a formal consultation to see what is best for you and your goals. Best, Dr. Emer.

Clearly, from your question, you have done extensive consultation with Drs. Google & YouTube. However, before jumping into expensive and extensive surgeries that entail prolonged postoperative healing and the potential for scars, you might consider the following totally non-invasive, nonsurgical approach that typically yields immediate results and involves no cutting and little to no significant downtime. The use of an appropriate HA lifting filler for cheeks would likely not only improve the volume deficit there, but secondarily improve the under-eyes, smooth the transition between upper cheeks and lower lids, and lessen the deep smile lines. Another HA filler appropriately placed would straighten the downturned angles of the mouth and eliminate the marionette lines. And finally, if so desired, Botox can be used to diminish the forehead "worry lines" and "eleven lines" between the eyes. Keep in mind that if you go out straight away asking for surgery, you will likely find someone more than happy to accommodate your request, but that doesn't necessarily mean that it is the best way or even the most appropriate way to treat the issues. Hope this helps and best of luck.

Your best option is a transcutaneous lower blepharoplasty with removal of fat and skin. You could benefit from laser resurfacing in addition to this, but this will not remove the need for surgery. Please visit with a board-certified plastic surgeon. Good luck!

so you have a fairly classic mid facial, aging combination of midfacial descent, leaving a noticeable, tear trough, thinning of the skin and early orbital septum failure.

This is due to the maxilla shortening and becoming more anteriorly tilted.

You are just getting beyond where additional volume into the tear trough is a good option. I think you're getting towards mid facelift territory.

I have a video on this particular procedure on my YouTube channel Adam goodwin surgery if you'd like to watch it.

Hope that helps. Best wishes, Adam, Goodwin.