Eyelids surgery - 31 years old? (photo)

I am very dissatisfied with the state of my skin around eyes - tired look, lots of wrinkles, saggy skin. I am 31 years old. Is upper and lower blephoplasty recommended? All other facial skin (except one around eyes) is perfect, no wrinkles.

Doctor Answers 9

Eyelid surgery/blepharoplasty does not improve under eye wrinkles, but there are several non-surgical options for them

As an oculoplastic cosmetic and reconstructive surgeon, I deal with these types of concerns everyday in my practice. Wrinkles and excess skin are not always synonymous. In fact, blepharoplasty, a surgical procedure defined by removal of extra skin, addressing fat pockets, puffy bags under the eyes as well as over the eyes, will not make a significant improvement when you’re dealing with the textural quality of skin.

When I look at a patient, I determine their age and skin type. It’s very well established that people who are Caucasian and lighter skinned will have more accelerated aging of the skin manifested by fine lines and wrinkles compared to the African-American skin type. Genetics play a major role in skin aging as well as what’s going on in the inside and outside of the body. Fine lines, wrinkles, aging will be accelerated by smoking whether it’s from carbon monoxide or generation of free radicals and other cell wall damages because of smoking. If you do smoke, consider stopping. Sun exposure is also a major factor in photoaging. If you spend a lot of time in the sun or you live in a place where there’s incidental sun exposure, then you have to be mindful of always wearing sunblock and avoiding the sun as much as you can.

The skin under the eyes is only half a millimeter thick so there are limitations on what kind of fillers or other options you have. A non-surgical strategy which includes neurotoxins such as Botox or Dysport, fractional cO2 laser and regeneration technique using platelet-rich plasma is the right for someone like you.

To address the fine lines and wrinkles, we have to reduce the activity of the muscles. With the photo you submitted, it appears that you are squinting a little bit and you’re smiling. The wrinkles that are generated are called dynamic wrinkles. Dynamic wrinkles means that a muscle is activated and those wrinkles appears. We manage dynamic wrinkles using materials such as Botox or Dysport. These are neurotoxins that are injected directly into the muscle in a very specific way to minimize the activity of those muscles so that those wrinkles are less likely to form. Not only does the residual activity of the muscle diminish, those lines become less pronounced.

When the wrinkles are present at rest, they are called static wrinkles. These are the crisscross wrinkles that are around the eye and are parallel to the muscle around the eye called the orbicularis oculi muscle. For treating those lines, we have several options. Some involve lasers such as a fractional cO2 laser. With lasers, we’re applying thermal energy in a very specific way to tighten the skin and to resurface the top layers of the skin. It doesn’t eliminate wrinkles but improves the appearance of the lines.

Something else that we do and is slowly becoming well known is the use of platelet-rich plasma. Platelet-rich plasma is derived from your own blood and it is the concentration of the healing aspects of the blood called the platelets. Platelet-rich plasma contain growth factors called vascular endothelial growth factors which stimulates blood supply. All of that has been shown to significantly enhance skin quality. It has a reversing effect to the changes of aging skin. I hope that was helpful, and thank you for your question.

New York Oculoplastic Surgeon
4.3 out of 5 stars 72 reviews

Eye options for a 31 y/o

There are always things you can choose to do... but what are you most concerned about? Your photos suggest that your biggest problem is the skin laxity of the lower lids. You can start with Retin A or some other topical exfoliant and consider fractional resurfacing to smooth and tighten the skin for a better look. Are the crow's feet an issue? If so, Botox and even resurfacing if you want. Upper lids? Depends on whether you're up for elevating your brows or filling the deep sulcus. So you have lots of choices but they depend on what you are more concerned about. And choose wisely.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

You would benefit from a few things in this area.

Botox or dysport will help decrease the crow's feet, and help to elevate the outer brow which looks a little low. Filler in the tear trough should help the skin in the lower eyelid. Some laser such as fractionated CO2 or erbium will also help the texture. You should start a good skin care regimen too -- including a retinol and moisturizer.

John J. Martin, Jr., MD
Coral Gables Oculoplastic Surgeon
5.0 out of 5 stars 28 reviews

Eyelid wrinkles, treatment options

Hi, based on your limited picture, your treatment options vary from less invasive to more aggressive with long term results proportional to the treatment.

The least invasive would be placing some botox around the lower eyelid to improve the creases in and around the lower lid, that may be your best and least invasive option, results should last from 3-6months. Other options to improve the lines around the lower lid include laser resurfacing as well as botox or a lower blepharoplasty to remove some excess skin from the area. I do not see much excess skin on the upper lids based on your photo.

Dilip D. Madnani, MD, FACS
New York Facial Plastic Surgeon
4.8 out of 5 stars 90 reviews

Upper and lower eyelid surgery

The primary goal of upper eyelid blepharoplasty is remove extra skin and a small amount of fat. The primary goal of lower eyelid blepharoplasty is to remove the puffiness( fat) and slightly improve excess wrinkles. The wrinkles on the lower lids are best addressed with a pinch technique of excess skin closed with tissue glue.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 145 reviews

Non surgical treatment is your best option.

I strongly recommend a microdroplet botulinum toxin forehead lift and under eye fillers using Restylane. Do your home work and find a top notch physician injector and not Sally Spa. Real service will cost more but it is definitely worth it.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Blepharoplasty at age 31

Hello and thank you for your question.

You may well be a candidate for an upper eyelid blepharoplasty. It's difficult to say from only this picture, and unfortunately, even more difficult to say much about the lower eyelids because I can not tell from the picture if you have excess fat of the lower eyelids. I do see some skin excess (although it appears you are smiling, so you would need to be seen in repose to accurately assess skin quality and excess). I offer my patients CO2 laser resurfacing of the lower eyelids for those that do not necessarily need surgical treatment. I recommend that you see a board certified plastic surgeon in consultation to get more specific answers to your questions which can best be addressed after a thorough history and examination is performed.

Best of luck to you

David L. Cangello, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 15 reviews

Eye lid skin wrinkles

The fine lines around the eyes may be amenable to laser or chemical peels. If you have loose skin a skin pinch removing some of the excess may be beneficial. Best to be seen in person.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Botulinum toxin for dynamic eyelid wrinkles

Need a photo without smiling. Lower blepharoplasty is risky at this age. If the problem is only during smiling, then botulinum toxin injection is helpful. See an oculoplastic specialist for evaluation.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 74 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.