Am I a good candidate for a lower blepharoplasty? (Photo)

Question

My lower eyelid bags really bother me. The skin is so bunched when I smile. I seem to have a lot of excess skin but I don’t have prominent eye bags, more of a slight hollow. I have tried tear trough filler in 2020 which I think made it worse and I’ve also done Co2 under my eyes. Photo 1 is at rest, photo 2 is soft smile and photo 3 is big smileZ Am I a good candidate for a blepharoplasty? Thanks

Randal Haworth, MD, FACS · Answer

Based on your pictures, you are an excellent candidate for a lower blepharoplasty with excess skin removal.

Make sure to consult with a board certified plastic surgeon who has a good eye for the best results.

Best of luck !

Christopher David Jones, MBBS, BSc, FRCS (Plast) · Answer

From the photos I can see hollowing of the lower eyelids with hyperactivity of the lower fibres of orbicularis muscle on animation. You don't appear to have skin excess. 
You could be a candidate for transconjunctival blepharoplasty (incision in the back of the lower eyelid) with re-positioning of the lower fat pads to give volume to the hollowed area. This will avoid any skin excision. The hyperactive orbicularis muscle could be treated with Botox.
Alternatively, you could have filler/fat transfer to the hollowed area with Botox to muscle. This could be supplemented with further CO2 laser to the lower lid skin.
Ultimately, I would advise that you see a Plastic surgeon with an interest in facial aesthetics for full assessment.

Richard Zienowicz, MD · Answer

Hello and thank you for your question. My first reaction is to suggest a neuromodulator such a Botox for the undereye creasing. Nonsurgical options are also something I would suggest as, based on your photos, I do not believe that you would be a good candidate for surgery at this time - other then possibly a very small amount of fat grafting to conservatively fill the tear troughs. Best of luck to you.

Caner Kacmaz, MD · Answer

Hi! this is Arzu from Dr. Caner Kacmaz clinic. You have skin excess in lower eyelids and that causes bag. You are a very good candidate for lower blepharoplasty. if you contact with us we will me more than happy to help you
Kind regards

Ali Riza Öreroglu, MD · Answer

In fact, I think you are a very good candidate for lower blepharoplasty. It seems that you have a slight excess in skin and also a very minimal lower eyelid fat bags doing a no touch transconjunctival blepharoplasty. Would be a best option to correct your under eyelid form.

Lexie Wang, MD · Answer

Hi Bright. I would be careful with your lower eyelids especially because they look pretty good when you are at rest and not smiling. If you have too much skin removed (such as in a skin pinch lower bleph to attempt to tighten the skin), you are at risk for ectropion or lid retraction, which are not easy things to fix or deal with. What I see is some hollowing under the eyes (as you noted) as well as hyperactivity of your orbicularis oculi muscle. I would consider filler/fat to fill the hollowing (tenting up the skin in this area will automatically help tighten the skin), skin tightening treatments (laser/microneedling, which may require multiple sessions), and botox to the orbicularis muscle to try to decrease the activity. Also make sure you are already on good eye creams to boost your skin as much as you can!

C. Blake Perry, MD · Answer

You would be a good candidate for lower lid blepharoplasty with fat repositioning. This would take your natural fat and fill the tear trough giving you volume. In terms of the “bunching skin,” thoughtful neurotoxin is the best solution. Best to see an eyelid expert.

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