Lower bleph or cheek lift for under eye bags? (Photos)

Question

I’d be really grateful for some advice please. I’ve had eye bags since I was a tden and they’re worsening with age (I’m 39 now). I’ve always wanted a lower bleph. I went to see a facial plastic surgeon who said I could have it done. Then I saw an oculoplastic surgeon who told me lower bleph is riskier than most people think and that I’m even higher risk due to having cheek fillers one time (five years ago). He advised against a bleph, refused to operate (even if I got the filler dissolved) and said if I insisted he would refer me to a oculoplastic surgeon specialising in problem surgery. He suggested a cheek lift (mid-face lift) as an alternative to restore fullness to my cheeks and disguise and bags. please could I have some advice on what would be best? Thank you so much.

Kenneth D. Steinsapir, MD · Answer

This includes any filler that may exist behind the lower eyelid orbital septum, which can definitely cause a lower eyelid bag. You might need two rounds of enzyme to accomplish this. Whatever is left after enzyming is complete will define your lower eyelid issues. You may need surgery or you may be a candidate for better filler service. Options for the lower eyelid could include lower eyelid transposition, lower eyelid canthoplasty with skin pinch, or transcutaneous midface lift with or without an orbital rim implant. There is no substitute for an in person consultation. Generally you can have a fist round of enzyme at that visit.

Nelson Lee Novick, MD · Answer

You might wish to consider the use of a entirely nonsurgical approach: the use of a robust HA volumizing filler for cheek augmentation, which can secondarily help to mask the under-eye bags and smooth the transition between the upper cheeks and the under-eyes. 
If still necessary, or alternatively, you may wish to consider the following minimally invasive approach. I have also found that, following numbing with local anesthesia, the use of low intensity electrodessication, delivered via a very fine epilating needle fanned underneath the bags,  helpful for shrinking them. 
You would be wise to consult with an experienced, board certified cosmetic dermatologist. Hope this helps and best of luck.

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