Is surgery really my only option? (Photo)

Im 50 now and the under eye area of both eyes have changed drastically over the past two years. I posted a photo but it was not close up enough to really see what my concerns are so im adding this one. It accurately reflects my concerns. Thanks a million!

Doctor Answers 6

Under eye concerns

Thanks for you pictures. I assume you are referring to the shadowing in that area. You have a couple factors contributing to the under eye area appearing tired. Firstly, you have volume loss in your upper cheeks and tear trough areas and secondly, you have some fat herniation with mild excess skin. 

Replacing the volume by adding fillers would be a good start, its a non surgical option and would refresh your appearance by decreasing the shadowing in that area and even camouflage some of the fat herniating from the under eye area. Filler options vary from temporary injectables to fat transfer. 

Laser skin resurfacing would help tighten some of the skin in that area as well, further improving the results of the filler and lastly, a lower eyelid blepharoplasty would help as well to remove the slight fat herniation you have, but I feel that replacing the volume would be your first and best option. 


New York Facial Plastic Surgeon
4.8 out of 5 stars 78 reviews

Options are many

There are a few different surgical options that would be excellent for you:  Upper blepharoplasty, fat grafting, and laser resurfacing are the three that will give you the most effect for the price. If you are not interested in surgery and want something less dramatic (and less pricey, at least initially), you could consider only an upper blepharoplasty, and use fillers, and skin peels to improve the skin.Consult an experienced surgeon that is comfortable with all these options so that he can offer you what is best for you.

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 32 reviews

Is surgery my only option?

Dear Kelli,

The question you ask is a very important one.  There are multiple choices that are available to you, surgical and nonsurgical.  The overlying skin of the upper and lower eyelids can be treated (laser, chemical, etc) as we all have skin changes over time.  There appears to be excess skin of bilateral upper eyelids as well as some minor hollowing below along the lower eyelids.  For the upper eyelids, surgery can reduce the excess skin.  For the lower eyelids one can restore volume with fat or filler and produce a very nice result.  Ultimately I would recommend that you consult with a specialist to review the surgical and nonsurgical options available to you.  Hopefully this is helpful .

Be healthy and be well,
James M. Ridgway, MD, FACS

James M. Ridgway, MD, FACS
Bellevue Facial Plastic Surgeon
5.0 out of 5 stars 78 reviews

Lower eyelid surgery candidate

 From the one very limited photograph, it appears that there is some puffiness and excess skin in the lower lids which  can be addressed with a lower lid blepharoplasty. The primary goal for lower eyelid surgery to remove the fatty deposits creating the puffy look. The secondary goal is to  tighten loose skin with a pinch technique to address the inelastic skin in the lower lids. For many examples and more information, please see the link and the video below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 129 reviews

No surgery is not your only option.

You can do fantastic with just cosmetic botulinum toxin and hyaluronic acid fillers.  These treatments have the power to achieve temporary results that can be as powerful and in some cases actually better than what can be accomplished with surgery.  The key is finding a highly experienced injector who can achieve these results for you.  You will not find this type of work down the street at the medspa. 

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

Surgery my only option?

Thank you for your question. It is always difficult to tell with just one photo. However, you appear to have
some actinic (sun) damage, and hyperpigmentation. A non-surgical approach could include the right skin care
regimen using lightening agents, and light laser treatment such as IPL or BBL. The use of subcutaneous
fillers, either natural (fat grafts) or manufactured, can also make a difference. The best answer is that 'yes' there are alternatives to surgery. I would discuss these with your local specialist. Best of luck to you.

Michael F. Bohley, MD
Portland Plastic Surgeon
4.9 out of 5 stars 15 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.