Hollowness and wrinkles under my eyes - Am I a candidate for lower eyelid surgery? (photo)

Question

I would love some advise please what I need to sort out the hollowness and wrinkles under my eyes. Would a lower blepharoplasty help? Or would I need a fat transfer or perhaps both? The wrinkles are only there when I smile. I am female, 46 and slim. I've had filler & botox in the past which has really helped but I would prefer to not have to keep using this and have something a bit more permanent.

Kyle Kimura, MD · Answer

Great question and photos! 
It is hard to definitively say based on your photos, but it looks to me like you could potentially benefit from some combination of a lower blepharoplasty with fat transposition/repositioning for the hollowness. You could potentially have a skin pinch to excise some of the lower eyelid skin and tighten this area to address the wrinkles vs a laser resurfacing which is also a great option. There is also some hollowing of the upper eyelid and I would strongly consider fat transposition or fat grafting of this area to establish balance of the whole eye if you are interested in surgery. 
Hope this helps and best of luck!Kyle Kimura, MD

Leyla Arvas, MD · Answer

I understand how hollowness and wrinkles under the eyes can make you look tired or older than you feel. Based on your photo, it sounds like you’re dealing with a combination of volume loss (hollowness) and skin changes, which are common as we age, especially for someone with a slim facial structure like yours. Your Concerns:Hollowness under the eyes is often caused by age-related fat loss in the under-eye area, which can create a sunken appearance. Wrinkles when smiling are likely dynamic wrinkles caused by muscle movement and skin laxity, which become more noticeable with age.I recommended lower blepharoplasty and fat transfer. Lower blepheroplastyis excellent for addressing excess skin, fine wrinkles, and mild puffiness under the eyes. However, if your primary concern is hollowness, a traditional lower blepharoplasty alone may not be sufficient. Instead, we can combine it with fat repositioning or fat transfer to restore volume. Fat transfer is a fantastic option to address hollowness under the eyes. We can harvest fat from another area of your body (e.g., abdomen or thighs) and inject it into the under-eye area to restore volume and create a smoother, more youthful contour. This is a long-lasting solution compared to fillers and can also improve skin quality.And also temporal lift can help address mild sagging in the outer eye area and upper cheeks, which can indirectly improve the appearance of the under-eye area. It lifts and tightens the tissues, creating a more refreshed and harmonious look.For your hollowness in the upper eyelids, we can use fat transfer to restore volume there as well. This creates a more balanced and youthful appearance.

Chet Mays, MD · Answer

Thank you for your inquiry! By your photos, it looks like you would be a great candidate for a lower bleph procedure as that procedure will remove excess skin to your lower eyelids. I recommend scheduling a consult appointment with a board certified plastic surgeon like myself so we can assess your eyes, listen to your goals, and create a surgical plan that is best for you and your goals!

Nelson Lee Novick, MD · Answer

I am happy to hear that you have had gratifying results in the past using Botox and fillers, which may be the most appropriate route to continue to go, despite the lack of very long-lasting results with this approach.. 
Why? Well, besides being expensive and often engendering significant post-treatment downtimes, the results are not as permanent as imagined. Although the surgery creates a permanent result in the skin and tissues, as we age, every few years we continue to lose underlying fat, bone, muscle and fibrous tissues, which, naturally, will result in a change in our appearance that likely will necessitate additional cosmetic work or more surgery. So, to repeat, the results of the surgery may be permanent, but, unfortunately, we are not.
The advantage of Botox and fillers is that their use can be adjusted to match the  inevitable age-related changes in our skin and underlying tissues as they appear. I hope this helps in your decision-making and best of luck..

Hollowness and wrinkles under my eyes - Am I a candidate for lower eyelid surgery? (photo)

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Hollowness and wrinkles under my eyes - Am I a candidate for lower eyelid surgery? (photo)

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